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4 <br /> ���'� 02 -24 -2009 <br /> ALEX SINK STATE OF FLORIDA <br /> CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES <br /> DIVISION OF WORKERS' COMPENSATION <br /> * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * <br /> CONSTRUCTION INDUSTRY EXEMPTION <br /> This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. <br /> EFFECTIVE DATE: 02/24/2009 EXPIRATION DATE: 02/24/2011 <br /> PERSON: KARSTEN JEFFREY E <br /> FEIN: 204523757 <br /> BUSINESS NAME AND ADDRESS: <br /> COASTAL COOLING HEATING & AC INC <br /> P 0 BOX 6055 <br /> BRANDON FL 33508 <br /> SCOPES OF BUSINESS OR TRADE: <br /> 1- CERTIFIED AC CONTRACTOR <br /> IMPORTANT: Pursuant to Chapter 440 . 05(14), F.S., an officer of a corporation who elects exemption from this chapter by tilieg a certificate of election seder this <br /> section may not recover betel its or compeasatioa ander this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the <br /> scope of the business or Node listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of <br /> election to be exempt shall be subject to revocation if, at any time after the filisg of the notice or the issuance of the certificate, the perses named on the notice or <br /> certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person <br /> named on the certificate to meet the requirements of this section. QUEST' J " 'R50) 413-1609 <br /> DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 <br /> 8013VNJNO3 3V OMAUM3D - <br /> aQVELL HO SS3NISf18 AO 3dO3S <br /> 80SCC ld 'NOONV88 <br /> 5508 X08 O d <br /> 3NI 3V 'V 0Ie1V3H ONI1003 Fr1SV03 <br /> :SS3LHOOV cINV 3V VN SS3NISf18 <br /> 1 LSLCES*OZ N11I3d <br /> N31S?JVN 3 A3BAJ3P NOSd3d <br /> tI,OZ /Pi /ZO :31V0 NOIiV$IdX3 6O0Z /4Z /ZO :3A11333j3 <br />