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\\ <br /> 11-24-2009 <br /> ALEX SINK STATE OF FLORIDA <br /> CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES <br /> DIVISION OF WORKERS' COMPENSATION <br /> * * CERTIFICATE OF ELECTION 70 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: 11/24/2009 EXPIRATION DATE: 11/24/2011 <br /> PERSON: HOCH KEVIN <br /> FEIN: 200640754 <br /> BUSINESS NAME AND ADDRESS: <br /> FIRE SYSTEMS INC <br /> 2824 68TH ST N <br /> SAINT PETERSBURG FL 33710 <br /> SCOPES OF BUSINESS OR TRADE: <br /> 1- FIRE EXTINGUISHER SERVICE 2- FIRE SYSTEM INSTALLATION <br /> IMPORTANT: Purswht to Chapter 440. 09(141, F.S., en olHear of a corporation who elects exemption from MO chapter by filing a certllkate of election inter Ibis <br /> sectioe may net recover beneffls or compensation enter this cMplor. P.rssaht to Chapter 400.09(121, r -s.. Certificates of election to be exempt ,. apply only within trio <br /> or.r. M Mn enxlnnaa or traie lisr■d an Me neliee 01 election rat be .x0511. Potaexc 10 L hnplet 440.05113), F,S., Notices of election to be exempt and certificates of <br /> election to be exempt rh.H be subject to revseelion If, at any time otter the Itliap at mo <br /> 1100e11 or tM iaaemcr vl Orr urr.11ie►re, trio p wooed on thr wine or <br /> r.rllfIcete no linger meets the renoiremenls of this section for Iszaance of a cortilicele. The department shall revoke a certificate al any time for ware of the perm <br /> meed on the eertiilcale in meet the requirements si Mix seetlon, <br /> OWC -252 CERTIFICATE OF ELECTION TO. BE tX MPT REVISED 09 - 06 QUESTIONS? (8501 413-16D9 <br /> PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE <br /> 6TATE of FLORIDA IMPORTANT <br /> DEPARTMENT OF FINANCIAL SERVICES .; s • y F <br /> DIVISION OF WORKERS' COMPENSATION Pursuant to Chapter 440.05(141, F.S. , an officer of a corporation who <br /> CONSTRUCTION INDUSTRY _ -' O elects exemption from this chapter by filing a certificate of election <br /> CERTIFlI:aTF OF ELECTION TO BE EXEMPT FROM FLORIDA d - <br /> • , . L under this section may not recover benefits or compensation under this <br /> WORKERS' COMPENSATION LAW D chapter. p <br /> EFFECTIVE 11/24/2009 EXPIRATION DATE: 11/24/2011 Pursulmt to Chapter 440,05(121, F.S., Certificates of election to be <br /> PERSON: KEVIN NOM H exempt„ apply only within the scope of the business or trade listed on <br /> FEIN; 200840754 R the notice of election to be exempt. <br /> BUSINESS NAME AND ADDRESS: E Pursuant to Chapter 440.05(13), ES., Notices of election to be exempt <br /> nor sysTcars nve and certif ;cats& of election to be exempt shell be subject to rervnrntinn <br /> 38711 NTH IT N If, at any time after the filing of the notice or the issuance of the <br /> SAINT PETERSBUCC, FL 32710 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 shell revoke a certificate at any time for failure of The <br /> SCOPE OF BUSINESS OR TRADE person named on the certificate to meet the requirements of this <br /> 1- FIPC EXTINcu1SN¢R SERVICE, 2- FIRE SYSTEM nrSTALLATION Section. <br /> QUESTIONS? 16601 413 -1609 <br /> CUT HERE <br /> Carry bottom portion on the Job, keep upper portion for your records. <br /> OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 <br />