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. • <br /> K, <br /> 02- 12-2009 <br /> ALEX SINK STATE OF FLORIDA <br /> CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES <br /> DIVISION OF WORKERS' COMPENSATION <br /> • <br /> . * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS COMPENSATION LAW * * <br /> CONSTRUCTION INDUSTRY EXEMPTION <br /> • <br /> This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. <br /> EFFECTIVE DATE: 02/12/2009 EXPIRATION DATE: 02/12/2011 <br /> PERSON: VARA ROLANDO <br /> FEIN: 201707388 <br /> BUSINESS NAME AND ADDRESS: <br /> VARA ELECTRIC CORP <br /> 6135 LANSHIRE DR <br /> TAMPA FL 33634 <br /> SCOPES OF BUSINESS OR TRADE: <br /> 1- REGISTERED ELECTRICAL CONTRACT <br /> IMPORTANT: Pursuant to Chapter 440 . 05(141, F.S., an officer of ■ corporation who elects exemption from this chapter by filing a certificate of election ender this <br /> section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12). F.S., Certificates of election to be exempt... apply oaly 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 nay time after the tiling 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 :bell revoke a certificate at any time for failure of the person <br /> named oft the certificate to meet the regoiremeots of this section. <br /> QUESTIONS? (850) 413 -1609 <br /> DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 <br /> PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE <br /> STATE OF FL8RIDA IMPORTANT <br /> DEPARTMENT OF FINANCIAL SERVICES <br /> DIVISION OF WORKERS' COMPENSATION F Pursuant to Chapter 440.05114). F.S., an officer of a corporation who <br /> CONSTRUCTION INDUSTRY <br /> elects exemption from this chapter by filing a certificate of election <br /> CE R FI O _ MFENSATIONN LTOO BE EXEMPT FROM FLORIDA fi sr L under this section may not recover benefits or compensation under this <br /> D chapter. <br /> EFFECTIVE: 02/12/2009 EXPIRATION DATE: 02/12/2011 Pursuant to Chapter 440.05112), F.S., Certificates of election to be <br /> PERSON: ROLANDO VARA H <br /> exempt... apply only within the scope of the business or trade listed an <br /> FEIN 201707388 R the notice of election to be exempt <br /> BUSINESS NAME AND ADDRESS: E Pursuant to Chapter 440.05113), F.S., Notices of election to be exempt <br /> VARA ELECTRIC CORP P <br /> and certificates of election to be exempt shall be subject to revocation <br /> 6135 LANSHIRE DR if, at any time after the filing of the notice or the issuance of the <br /> TAMPA. FL 33834 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 shall 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- REGISTERED ELECTRICAL CONTRACT section. <br /> QUESTIONS? 18501 413 -1609 <br /> CUT HERE <br /> * Carry bottom portion on the job, keep upper portion for your records. <br /> DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06 <br /> E'd SSSE2C2 -ETB 3WI SN3Q1IflU 3HC eisS :OT OT 0T AoW <br />