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' PL'EASE CUT dUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE <br /> STATE OF RORIDA IMPORTANT <br /> DEPARTMENT OF FIIVANCiAL SERVICES F Pursuant to C ter 440.05(14), F_S., an officer of a corporation who <br /> DIVIStON OF WORKEi2S' COMPENSATION �° O �P <br /> CONSTRUCTIQN INDUSTRY elects exemption from this chapter by filing a certificate o# election <br /> CERTfFICATE O� ELECTION TO BE EXEMPT FROM FLORIDA �- under this section may not recover benef its or compensation under this <br /> WORKERS' CQPrtPENSATION LAW 1 `�° � chapter_ <br /> EFFECTIVE 06l2St2009 EXPIRATION DATE: 06l25/2011 pursuant to Cfiapter 440.05(121, F.S., Certificates of election to be <br /> PERSOiW. Ff2AN8C H MCKIt�IEY H exempt... apply onty within the scope of the business or t�ade listed on <br /> FEIPk 202560924 E ihe notice of efection to be exampt <br /> R <br /> BUStNESS NAME AND ADDRESS: E Pursuanr to Chapter 440.054131, F_S_, tdotices of election to be exempt <br /> SOLAR SHIELD IPiDUSTRIES iNC and certificates of election to ise exempt shal! be subject to revocation <br /> iszi ee 29TH ave if, at any time after the filing af the notice ar the issuance ot the <br /> OCALq FL aaa�o eertificate, the person named on the notice or certificate no longer meets <br /> the requirements of this sectiort for issuance of a certificate. The <br /> deparUnent shall revoke a certifiicate at any time for failure of the <br /> SCOPE O� BUSINESS OR TRADE persan named an the certificate to meet the requireme�ts of this <br /> 7- CERTIFIED ROOFING CONTRACTOR 2- CERTIf1ED GENERAL CONTRACTOR 58C1t0I1. <br /> QUESTIONS? (850? 413-1609 <br /> CUT HERE <br /> � Carry bottom portion on the job, keep upper portion for your records. <br /> "9 � .d'�, r •' - - — _ ' <br /> . � o .+.%:..s 'n <br /> zr, � - <br /> s �a" ;_ICE►�tSE CLGtSS " <br /> � �. , w., 7�S�.,p`, t.��"" <br /> � <br /> � r ' .': t� <br /> ?dfl . .. "F <br /> DWC-252 CERTIFICATE OF EIECTION TO BE EXEMPT F � � s�qt S� 53RD AVE <br /> x' ;� nCAi1a. Fl. 9et4ffD�00 <br /> "��� t?�ss: t2-t12-�96fl SEx.1t9 <br /> .,`� ' , �SSt7Eb 11-25-240� ' � .- • <br /> ' F_.7fPtR£S 12-02-2r b <br /> . �_�� � <br /> CC <br /> f .�+�.. /. .L �>1�v.y <br /> '�� ' _. � �nEQ�..�iC'�`�i'�' ��"�b� � <br /> . 'ORCYCLE ALSG� ' <br /> �hr.rt��n n� a m[)tor vrMtle ' M�': t�st�f�MV tP°.t ��C�++rrA ts� t <br />