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"t HE <br /> • 6 ` `' 08 -05 -2008 <br /> • <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: 08/05/2008 EXPIRATION DATE: 08/05/2010 <br /> PERSON: BEAUCHAINE MICHAEL E <br /> FEIN: 223953546 <br /> BUSINESS NAME AND ADDRESS: <br /> SHINGLE MASTERS ROOFING & CONSTRUCTION SERVICES iNC <br /> 2502 CULBREATH COVE CT <br /> VALRICO FL 33594 <br /> SCOPES OF BUSINESS OR TRADE: <br /> 1- REMODELING 2— CERTIFIED ROOFING CONTRACTOR <br /> 3- CERTIFIED GENERAL CONTRACTOR <br /> IMPORTANT: Pursuant to Chapter 440. 051141, F.S., an officer of a corporation who elects exemption fpom this chapter by filing a certificate of election under this <br /> section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(121, F.S., Certificates of election to be exempt... apply only within the <br /> scope of the business or trade 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 filing of the notice or the issuance of the certificate, the person 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. <br /> )WC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 QUESTIONS? (850) 413-1609 <br /> • <br /> • <br /> • <br /> • <br />