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- , <br /> 11-17 -2010 <br /> `'�4 4E � `� <br /> AIEX 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 WORKBtS' COMPENSATION LAW *� <br /> CONSTRUCTION INDUSTRY EXEMPTION <br /> This certifies that the individual listed below has elected to be exempt from Florida Woricers' Compensation law. <br /> EFFECTIVE DATE: 11/17/2010 EXPIRATION DATE: 11/16/2012 <br /> PERSON: SMITH PATRICK F <br /> FEIN: 550864751 <br /> BUSINESS NAME AND ADDRESS: <br /> M& P SMITH INVESTMENTS INC <br /> DBA M&P SECURITY <br /> 8217 VASSAR CIRCLE <br /> TAMPA FL 33634 <br /> SCOPES OF BUSINESS OR TRADE: <br /> 1- ELECTRICAL WOitlC 2- CONSTRIJCTION <br /> 3- SECURITY SYSTEMS <br /> IMPORTANT: Prrsaa�t to CMpter 440 . 05(14►, F.S., a� ofFicer af a corpontio� w6o elects exawptto� frow Mis cMyter by filisg a certiHcrte al electioe ���er tAis <br /> seciioa esy wt recorer be�efits or coopensaUo� ua�er IMIs cMapter. Prrsu�n m CM�pter 440.08(121, F.S., CertiHatas of alecHo� �o Ae ezswpt... ayply ealy witMi� tpa <br /> scepe a( IAe h�si�ess or tn�e listei ea tke notice of eleMia� ta be exewpt. Pwar�At �o CY�pter 440.051191. F.S., Natices of eleqiae to 6a exa�pt ui certific�tes af <br /> eleetio� to be exeapt sMall be s�bject to revoetlioe il, a[ �ay tiwe �fter Ne fili�g of tAe eotice or lMe isau�ee af t1e certilicNe, Ue persa� name! oa Ne wtice or <br /> certificate ao longer seets tMe reqeireme�ts ot tMis sectioa for issrwce of � certtficate. The dap�rtee�t sMall revoMe a certi(icate at asy [iwe for f�ilers of tMe persoa <br /> na■ed on the certiFicne to weet t6e reqriremests of t4is seaioe. QUESTIONS? (85D) 413-1609 <br /> DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 <br /> PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE <br /> STATE OF FLOttIDA IMPORTANT <br /> DEPARTMENT OF FlNANCIAL SEtVICES <br /> DIVISWN OF WORKERS' CoMPENSATION F Pursuant ta Chapter 440.051t4), F.S., an ofticer of a corporation who <br /> WNSTRUCTIQN INCUSTRY � elects exemptiai from this chapter by filing a certificate of election <br /> CHtTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA L�der this section may not recover benefits or compensation under this <br /> 4YORKERS� COMPENSATtON LAW � chapter. <br /> EFFECTIVE 11/17/2010 EXPIRATION DATE: 11/16/2012 H pursuant to Chapter 440.05(17a, F.S., Certificates of election to be <br /> PERSON: PATRICK F SMITH exempt.. �ply only within the scope of the business or trade listed on <br /> FEIN: 550864751 R ffie notice of election to be exempt <br /> BUSINESS NAME AND ADDRESS: E Pursu�t to Chepter 440.05i131, F.S., Notices ot election to be exempt <br /> M& P SMITH INVESTMENTS INC and certificates of election to be exempt shall be subject to revocation <br /> DBA M&P SECURITY if, at any time after the filing of the notice or the issuance of the <br /> 8217 VASSAR CIRCLE certificate, the perso� �ned on the notice or certificete no longer meets <br /> TAMP/� FL 33634 the requiremeMS of �is 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 requiremerrts of this <br /> 1- EIECTRICAI WORK 2- CONSTRUCTION section. <br /> 3- SECURITV SYSTEMS QUESTIONS? (850) 4�3 <br /> CUT HERE <br /> +� Carry bottom portion on the job, keap upper portion for your records. <br /> DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06 <br />