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o�..�. °�� <br /> �� <br /> � { <br /> � � 1 10-18-2010 <br /> �:��„�: <br /> ALEX SINK STATE OF FLORIDA <br /> CHIEFFINANCIALOFFICER 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 �e�tifies that the individual listed below has elected to be exempt from Florida Workers' Compensation (aw. <br /> EFFECTIVE DATE: 12/p9/2010 EXPIRATiON DATE: 12/08/2012 <br /> PERSON: MCKINNEY GERALD y�/ �� <br /> FEIN: 593649569 <br /> BUSINESS NAME AND ADDRESS: <br /> NATIONAL HOMECRAFT OF CENTRAL FLORIDA INC <br /> 6061 CINDERLANE PKWY STE 100 <br /> ORLANDO FL 32810 <br /> SCOPES OF BUSINESS OR TRADE: <br /> 1- ROOFING CONTRACTOR 2- GENERAL CONTRACTOR <br /> IMPOHTANT: Pursuant to Chapter 440 . OS(14), F.S., an oEFicer of a corparation who elects exemption from this chapter by (iling a certi(icate ot electian under this <br /> section may not recover benefits ar �ompensation under this chapter. Pursuant to Cbapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the <br /> scope of the business or tnde Iisted on the no[ice of election to be exempt. Pursuan[ to CAapter 440.05(13), F.S., No[ites of elettion to be exempt and certificates oE <br /> election to be exempt shall be suhject to revocation (f, at any time after the filing of the notice or the issuanee of the eertifieate, the person named on tde notice or <br /> certificate no longer meets the requirements of tdis section for issuance ot a certificate. The department shall revoke a certificate at any time for failure of the person <br /> named on the certificate to meet the requirements of this section. <br /> DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06 QUESTIONS? {850) 413-1609 <br /> PLEASE CUT OUT THE CARD BELOW AND RETA(N FOR FUTURE REFERENCE <br /> STATE OF FLORIDA <br /> DEPARTMENT OF FINANCIAL SERVICES F IMPORTANT <br /> I DIVISION OF WORKERS� COMPENSATION O Pursuant to Chapter 440.05{14), F.S., an officer of a corporation who <br /> ; CONSTRUCTION INDUSTRY elects exemption from this cha y g <br /> I CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA L pter b filin a certificate of election <br /> WORKERS' COMPENSATION LAW '. -�� � under thiS section may not recover benefits or compensation under this <br /> EFFECTIVE: 12/09/2010 EXPIRATION DATE: 12/08/2012 � chapter. <br /> PERSON: GERALD W MCKINNEY II H Pursuant to Chapter 440.05(12), F.S., Certificates of election to be <br /> FEIN: 593649569 E exempt.. apply only within the scope of the business or trade listed on <br /> R the notice of election to be exempt <br /> BUSINESS NAME AND ADDRESS: <br /> NATIONAL HOMECRAFT OF CENTRAL FLORIDA INC E Pursuant to Chapter 440.05(13) F.S., Notices of election to be exempt <br /> sosi CINDERLANE PKWV STE ioo and certificates of election to be exempt shall be subject to revocation <br /> oR�aHOO, F� 3zs,o if, at any time after the filing of the notice or the issuanc� 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 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 /> 7- ftOOFING CONTRACTOR 2- GENERAL CONTRACTOR section. <br /> QUESTIONS? (850) 413 <br /> CUT HERE <br /> � Carry bottom portion on the job, keep upper portion for your records. <br /> )WC-252 CER'fIFICATE Of ELEL'TION 70 BE EXEMPT REVISEO 09-06 <br />