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440: t <br /> IEFLEMZING <br /> ALEX SINK <br /> CHIEF'FINANCIAL OFFICER <br /> STATE OF FLORIDA <br /> August 14, 2009 <br /> VERIFICATION OF AUTOMATIC EXEMPT STATUS FROM WORKERS' COMPENSATION <br /> COVERAGE REQUIREMENTS <br /> This letter verifies that the individual listed below is AUTOMATICALLY EXEMPT from Florida workers' <br /> compensation coverage requirements within the scope of the non - construction business or trade listed below and is <br /> not required to obtain an exemption issued by the Division of Workers' Compensation in order to achieve exempt <br /> status. <br /> PERSON: ADAM BROOKS <br /> BUSINESS NAME: BROOKS MOBILE HOME SERVICE LLC <br /> ADDRESS: 9716 DELS ACRE ROAD <br /> THONOTOSASSA, FL 33592 <br /> TYPE OF NON - CONSTRUCTION <br /> BUSINESS OR TRADE: MOBILE HOME SET UP <br /> CLASS CODE OF BUSINESS: 8380 <br /> This verification of automatic exempt status applies ONLY within the scope of the non - construction business or <br /> trade listed above, and applies ONLY to the individual listed above. However, if <br /> BROOKS MOBILE HOME SERVICE LLC employs four or more full or part -time employees, it must obtain <br /> workers' compensation coverage. A member of a limited liability company engaged in the non - construction <br /> industry is considered an employee if the member meets the definition of employee as defined in Section <br /> 440.02(15)(a), Florida Statutes. If a policy is in effect for the limited liability company engaged in the non - <br /> construction industry and the member meets the definition of employee as defined in Section 440.02(15)(a), Florida <br /> Statues, the payroll of such member may be included in determining the premium for the policy. <br /> If BROOKS MOBILE HOME SERVICE LLC engages in a construction- related activity as defmed in section 440.02(8), <br /> Florida Statutes, or in Rule 69L- 6.021, Florida Administrative Code, the automatic exempt status for ADAM BROOKS <br /> shall not apply, and BROOKS MOBILE HOME SERVICE LLC must comply with workers'. compensation coverage <br /> requirements for the construction industry. <br /> If ADAM BROOKS is a corporate officer as defmed in Section 440.02(9), Florida Statutes, this Verification of Automatic <br /> Exempt Status from Workers' Compensation Coverage Requirements does not apply. In order to become exempt, <br /> ADAM BROOKS is required to complete an exemption application and submit the application to the Division of Workers' <br /> Compensation. If the Division of Workers' Compensation determines that ADAM BROOKS meets the eligibility <br /> requirements for the issuance of an exemption, the Division of Workers' Compensation will issue an exemption to <br /> ADAM BROOKS. <br /> If you have any questions, please call (850) 413 -1609. <br /> DMSION OF WORKERS' COMPENSATION - BUREAU OF COMPLIANCE <br /> 200 EAST GAINES STREET - TALLAHASSEE, FLORIDA 32399 -4228 - PHONE 850 - 413 -1609 <br /> AFFIRMATIVE ACTION - EQUAL OPPORTUNITY EMPLOYER <br />