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<br />......~~.]!.!.!;;... <br /> <br />ALEX SINK STATE OF FLORIDA <br />CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES <br />DIVISION OF WORKERS' COMPENSATION <br /> <br />* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW ** <br /> <br />CONSTRUCTION INDUSTRY EXEMPTION <br /> <br />This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. <br /> <br />EFFECTIVE DATE: <br /> <br />07/06/2007 <br /> <br />EXPIRATION DATE: 07/05/2009 <br /> <br />V <br /> <br />PERSON: TATUM <br />FEIN: 650547297 <br /> <br />BUSINESS NAME AND ADDRESS: <br />TATUM REfRIGERATION A/C SERVICES INC <br />POBOX 7837 <br />TAMPA fL 33673 <br /> <br />SCOPES OF BUSINESS OR TRADE: <br />1- REGISTERED MECHANICAL CONTRACT <br /> <br />VESTAL <br /> <br />IMPORTANT: Pursuant 10 Chapter 440 . 05(14), F.S., an officer of a corporation who elects exemplion from Ihis Chapter by liling a certilicale of eleclion under this <br />seclion may nol recover benefils or compensalion under this chapter. Pursuant 10 Chapter 440.05(12), F.S., Certificales of eleclion to be exempl... apply only wilhin Ihe <br />scope of Ihe business or lrade lisled on lhe nolice 01 election 10 be exempt. Pursuant 10 Chapler 440,05(13), F.S., Notices of election to be exempt and certificales of <br />election 10 be exempt shall be subject to revocation if, at any time alter Ihe liling 01 the notice or the issuance of Ihe certilicate, the person named on Ihe notice or <br />certificale no longer meets lhe requiremenls of Ihis seclion for issuance of a certificale, The departmenl shall revoke a certificale at any lime for lailure of the person <br />named on Ihe certilicate to meet Ihe requiremenls of Ihis section. <br /> <br />DWC- 252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06 <br /> <br />.--.--.-.-,..-.----.----..........-'-"-". .-~..___....-'---..r:;--S'.~.:;.-..._-.__ -.__ ~_ ,.,.._..._...._.....~......__......~_~.-......... <br /> <br />QUESTIONS? (850) 413-1609 <br /> <br />PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE <br /> <br /> <br />STATE OF FLORIDA <br />DEPARTMENT OF FINANCIAL SERVICES <br />DIVISION OF WORKERS' COMPENSATION <br />CONSTRUCTION INDUSTRY <br />CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA <br />WORKERS' COMPENSATION LAW <br /> <br />EFFECTIVE: 07/06/2007 EXPIRATION DATE: 07/05/2009 <br /> <br />PERSON: VESTAL V TATUM <br /> <br />FEIN: 650547297 <br /> <br />BUSINESS NAME AND ADDRESS: <br />TATUM REFRIGERATION Alc SERVICES INC <br />POBOX 7B37 <br />TAMPA, Fl 33673 <br /> <br />SCOPE OF BUSINESS OR TRADE: <br />1 ~ REGISTERED MECHANICAL CONTRACT <br /> <br />F IMPORTANT <br />Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who <br />OL elects exemption from this chapter by filing a certificate of election <br />under this section may not recover benefits or compensation under this <br />D chapter. <br /> <br />H Pursuant to Chapter 440.05(121. F.S., Certif icates of election to be <br />exempt.. apply only within the scope of the business or trade listed on <br />E the notice of election to be exempt. <br />R <br />E Pursuant to Chapter 440.05(131. F.S.. Notices of election to be exempt <br />and certificates of election to be exempt shall be subject to revocation <br />if, at any time after the filing of the notice or the issuance of the <br />certificate, the person named on the notice or certificate no longer meets <br />the requirements of this section for issuance of a certificate. The <br />department shall revoke a certificate at any time for failure of the <br />person named on the certificate to meet the requirements of this <br />section. <br /> <br />QUESTIONS? (850) 413-1609 <br /> <br />CUT HERE <br /> <br />* Carry bottom portion on the job, keep upper portion for your records. <br /> <br />DWC- 252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06 <br />