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<br />. 06-07-2007 <br /> <br />ALEX SINK STATE OF FLORIDA <br />CHIEF FINANCIAL OFFICER DEPAR:TMENT OF FINANCIAL SERVICES <br />DIVISION OF WORKERS' COMPENSATION <br /> <br />* * CERTIFICATE OF ELICTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * <br />CONSTRUCTION INDUSTRY EXEMPTION 0 <br /> <br />This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. <br /> <br />EFFECTIVE DATE: 06/07/2007 <br /> <br />PERSON: LLOYD <br />FEIN: 200653577 <br /> <br />BUSINESS NAME AND ADDRESS: <br />TREEHDUSE HOMES INC <br />6215 HARNEY RD <br />TAMPA FL 33610 <br /> <br />EXPIRATION DATE: 06/06/2009 <br />CHANTEL <br /> <br />SCOPES Of BUSINESS OR TRADE: <br />1- CERTIFIED BUILDING CONTRACTOR <br /> <br />IMPORTANT: Pur,u"1 10 ChlJller. 440 . 05114), F.S., .n aflicer at . carpor.lion. who elecls nelDplion trom Ihi. ch.pter by liIi.g . certlficale 01 .Ieclian un.er Ihis <br />,ecUon m.y nal recav.r benelil' or co......tion un.er Ihis ch.pler. Pur...nl 10 Ch.pl.r 440.0111121, F.S., C.rtlfic.l.s 01 .I.clian 10 be n..PI... .pply DAly wilhin Ihe <br />scope a' Ihe bu,in.ss or Ir.de Ii.led. on lIIe .olic. 01 .Ieclion 10 b. .x.mpl. Pur.llnl 10 Ch.pler 440.051'3), F.S., Nolices 01 .'.cllon 10 b. ....pl ..d c.rtiflc.l.s 01 <br />,",clion 10 be ....pl sh.1I be .ubj.cl 10 r.voc.lion If, .1 .ny Iille .It.r lIIe liIi.g 01 Ihe RoUce Dr Ihe l..a..ce ot lIIe certiflcale, Ihe p.rson ..lIed on lbe .olic. Dr <br />c.rtlfic.le no longer m.el. I.... r....ir..e.ts 01 Ibis seclian lor iss..nce of . cerlilieel.. The ..p.rtlDenl .h.1I revoke . c.rtilic.te .. ,.y lime lor 1.i1ure 01 Ihe person <br />DIlled on Ihe c.rtilic'le 10 meel Ihe req.ir.m.nls 0' Ihis section. <br /> <br />DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06 <br /> <br />QUESTIONS? 18501 413-160 <br /> <br />PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE <br /> <br />STATE OF FLORIDA <br />~~=~=xl~ eo..,..... <br />caN51'RUcTXON INDUSTRY <br />CERTFJeATE OF ELECTION To BE EXEMPT FROM FLORIDA <br />WCRKERS' COMPl!\lSATION LAW <br />EFFECTIVE: 08/07/2007 EXPIRATION DATE: 06/08/2001 <br />PERSON: CHANTEL LLOYD <br />FEIN: 200853577 <br />BUSINESS NAME AND ADDRESS: <br />TREEHOUSE HOMES INC <br />8215 HARNEY RD <br />TAMPA, FL 33610 <br /> <br />SCOPE OF BUSINESS OR TRADE: <br />1- CERTIFIED BUILDING CONTRACTOR <br /> <br />F IMPDRTANT <br /> <br />o Pursuant to Chapter 44o.05{141, F.S., an officer of a corporation who <br />. elects exemption from this chaptt!r by filing a certificate of election <br />L under this section may not recover benefits or compensation under this <br />D chapter. <br /> <br />Pursuant to Chapter 44o.o5{121, F.S., Certificates of election to be <br />o HE.. exempt.. apply only within the scope of the business or trade listed on <br />the notice of election to be exempt <br />R <br />E PurSllm1t to Chapter 440.051131. 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? 18501 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 />