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� - � �i <br /> ! 08 -31-2010 <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: 70/30/2010 EXPIRATION DATE: 10/29/2012 <br /> PERSON: FOENS JOHN W <br /> FEIN: 593459796 <br /> BUSINESS NAME AND ADDRESS: <br /> LIGHTNING ALUMINUM INC <br /> P 0 BOX 290144 <br /> TAMPA FL 33887 <br /> SCOPES OF BUSINESS OR TRADE: <br /> 1- ALUMINUM 2- CONSTRUCTION <br /> IMPOHTAN7: Pursuent lo Chepler 440 05114►, F.S., �n officer ol s corporstton who elecls exemption from this ch�pter by flling s certilicete ol electton under Ihis <br /> seciion msy na[ reeover 6enefits or compensstion enier thts ch�pter Pursuant to Chapter 440.051121, F.S., Ceritlic�[es ol elecllon to be ezempt.. spply only within the <br /> scope ot the business or trsde listed on the notice of election to be ezempl. Pursuenl ta Chapler 440.05113), F.S., Nolices of elecllon to be ezempt and certificetes o( <br /> elecltan to be exempt shall be subject lo revocation I(, at �ny lime �fter the liling of the notice or the issu�nce oI the cerlilicete, the person nemed on the notice ar <br /> cerlilic�te no longer meets the reqetrements of this section lor issuence of e ceni(ic��e. The dep�rtment shalf revoke a certi(icate st sny time (or f�ilure af the person <br /> nsmed on lhe certiffcate to meet the requtrements of this seclion. <br /> OWC-Z52 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06 QUESTIONS7 (850) 413-1609 <br /> -- -- -------------- <br /> PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE <br /> STATE OF FLORIDA <br /> DEPARTMENT OF FINANCIAL SERVICES IMPORTANT <br /> DIVISION OF WORKERS' COMPENSATION F Pursuant to Chapter 440.05(14), F.S., an officer of a cor oration who <br /> CONSTRUCTION INDUSTRY � elects exemption from this chapter by filing a certificate of election <br /> CERTIFlCATE OF ELECTION TO BE EXEMPT FROM FLORIDA �- under this Section may not recover benefits or compensation under this <br /> WORKERS' COMPENSATION LAW <br /> D chapter. <br /> EFFECTIVE: 10/30/2010 EXPIRATION DATE: 10/29/2012 <br /> PERSON: JOHN W FOENS Pursuant ta Chapter 440.05(11), F.S., Certificates of election to be <br /> H exempt.. apply only within the scope of the business or trade listed on <br /> FEIN: 593459786 E the notice of election to be exempt. <br /> BUSINESS NAME AND ADDRESS: R <br /> LIGHTNING ALUMINUM INC E Pursuant to Chapter 440.051131, F.S., Notices of election to be exempt <br /> P o eox 290144 and certificates of election ta be exempt shall be subject to revocation <br /> TAMPA, FL 33687 if, at any time after the filing of the notice or the issuance of the <br /> 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 shatl 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- ALUMINUM 2- CONSTRUCTION section. <br /> QUESTIONSI (850) 413-1609 <br /> CUT HERE <br /> � Carry bottom portion on the job, keep upper portion for your records. <br /> DWC-252 CEflTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06 <br />