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<br />ALEX SINK STATE OF FLORIDA <br />CHIEFFINANcrALOFl"lC~ DEPARTMENT OF FINANCIAL SERVICES <br />DIVISION OF WORKERS' COMPENSATION <br />if * CERTIFICATE OF ELECTION. TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * if <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 />.~~ <br /> <br /> <br />. . <br />r. ~ <br /> <br />04-17-2008 <br /> <br />EFFECTIVE DATE: <br /> <br />04/17/2008 <br /> <br />EXPIRATION DATE: 04/17/2010 <br />SeAN H <br /> <br />PERSON: . RI:ILL Y <br />FEIN: 841635264 <br /> <br />BUSINESS NAMe AND ADDRESS: <br />SEAN REILLV OONPLETE PLUMBINQ & WATER TREATMENt SERVICES INC <br />DBA SEAN REILLV PLUMBINQ <br />4844 H~ADL~~ DRIVE <br />O~LANDo <br /> <br />FL 32822 <br /> <br />SCOPES OF BUSINESS OR TRADe: <br />1- CONsULTANT <br />3- REMODELING: <br /> <br />2- DRAIN CLEANING <br />4- CLEANINC/RCNQVATING BUILDINaS <br /> <br />IMPORTANt: PlrsuOJII In Ch~pler 440 . 05114'. F.li.. ID olfice, of t C:prporttloR II'ftll elects r.llempriDn from 1II1~ eft.p'or by WIng . c:.rtlflcltl! of election UDder Ihls <br />,pclin I11RY lOT r!eO~er Den.flU or culllpe~'~;on R.fer Ihls CUPI.f. PIII'$~lnt 10 CII'pl., 44ll.05t121. F.S.. C~rtrli~Jtes 01 81~CliOft In h~ .~.mpL_ Rpply ..11' wi/hi.. I~e <br />'C:Op, 01 th! DlI$lnes~ .or InCl. IISleCl II rile nn/i.. of .'oCtl.n I. be e~"'.IIL PVrllll1 to n'p',r 440.D5(191, F.S.. !foliC:,. of ellcliOG TO be eXi!"1It IIId clrTlfieatlli of <br />eleCTlaR la De elllmpl ;hlll 110 liUlljeel to rcvoclliol If. ~ IRY lime .Illt tile fillRg of tlie nolice Dr Ill. Inulel /If II, cenifit8lt!. lIIe ,enan allied an !lie IllIic. Dr <br />cel'TlfiClI. no longer 11I881' lIle feqrriremeln of Ibis seclian fur iU8lRCe Ilf . Ul'Tlflc.lo. The "e,.rtmen, shill t,YOk~ . cenilicttl II Illy II.! fOt f.llare of I.. perllOR <br />..m.d 01 Ibe eenlficlle ta lII'el lb leqlirelTllRl1 Of Ihi, ~,i;UOR. <br /> <br />DWC-25.l I;MTlfrl:ATE OF ELECTION TO BE EXEMPT REVISED 09-06 <br /> <br />QUESTIONS? (850l .413-161 <br /> <br />...... ...... ....... ...---....--.-.-.-.....,..-.-.......--. .... -....... ......-._~....._--_.. ."'-"", .... <br /> <br />STA1"E OF rLORIcA <br />Da-AR,TMalT OF FINANCIAL S~VICEs _ <br />DIVISION OF WOIU(~ COIotPENSATlON <br />CONSTRUCTION INDUsTRY <br />C8~FlCAtt or- ~CTION TO BE ~ PROM FLORIDA . _' . <br />wtmkERS' COMPENSA,1'IoN LAw <br /> <br />EFFECTIVE: 04/17/2008 EXPIRATION DATE: 04/17/2010 <br />PE;R50N: SUN 1"1 REiLLY <br />FEIN: 841835284 <br />aUSlNESS NAME AND A.DDRESS: <br />SEAN REI1.LY COMPtETE PLlIMIIJNIO & W^1ER TREATMm SERVICES INe <br />08.11 SEliN RElT,~Y PLUMBING <br />4844 HEAo~"E DRIVG <br />O~LAI'ltIO. FL 32112:1 <br /> <br />PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE <br /> <br />SCOPE OF BUSINESS OR TRADE. <br /> <br />,. ~QNl:U~ TANT <br />3. f'lEMOOeLlNG <br /> <br />2. DRAIN CLEANING <br />4. CLEANING/RI1NOVATING BUILOINGS <br /> <br />IMPORTANT <br /> <br />F PlIrsuant tc Chapter 4.co.05(14). F.S., Iln afficer af II l".nrporstilll'r who <br />OL I:lec;ts exemption tram this chepter by filing a certificate of election <br />under this section InIlY ntlt recaYer benefits or campe~ion IIOder this <br />D chapter. <br /> <br />H "urSUllllt ta Chapter 440.05{12l. F.S.. Certificat~s of electian to be <br />E exempt.. applV anly within the seD"e of the business or:. trade' listed an <br />the notice of election to be e;!tempt. <br />R <br />E Pursuant ta Chapter 440.05(13). F.5.. NDtrces of election to be exempt <br />lIl"Id certificates af election fa be exempt shall be !lJbject to revacation <br />if, at any time after the filinll of tile nllti/!", or th.. isSllallCc: of thc <br />certificate, the Person named an the notice (lr certificetr: no longer meetl <br />the requirements 01 tIIis SectiDn for isslIlIIlce 01 a CertifIcate. TI1e <br />dep.tmettt shall revoke a cllrtific~ ~ any timll for fllilure 0.1 the <br />IIp.f!l:nn 118m.1f on the l:Cr1ifi~c tll ",cet 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 yo~ records. <br /> <br />OWC-252 CERTIFICATE OF ELECTION TO BE EXEMf'T REVISEO os-OS <br />