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1'°` ='rF�^. <br /> t ' � <br /> �., � 1 04-03-2012 <br /> ``�"���,�.f <br /> � <br /> JEFF ATWATER 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: 04/03/2012 EXPIRATION DATE: 04/03/2014 �-�'� <br /> PERSON: CLARK STEVEN S <br /> FEIN: 650899998 <br /> BUSINESS NAME AND ADDRESS: <br /> E A S INDUSTRIES INC <br /> 4500 LAKEVIEW DRIVE <br /> SEBRING FL 33870 <br /> SCOPES OF BUSINESS OR TRADE: <br /> 1- BURGLAR ALARM INSTALLATION 2- ELECTRICAL WIRING (5190) <br /> 3- CERTIFIED ALARM SYSTEM CONTRAC <br /> IMPORTANT Pursuant to Chapter 440 051141, f.S., an officer of a corporation who elects ezemption from this chap[er by filing a certifica[e of election under [his <br /> section may not recover beneFits or compensation under this chapter. Pursuant ta Chapter 440.051121, f.S., Certifitates of election to be ezempt. apply only within [he <br /> scope of the business or trade lis[ed on the notice af election to be exemp[. Pursuan[ to Chapter 440.05113), f.S., Notices of election to be exemp[ and cer[ifica[es oF <br /> election to be ezempt shall be subject to revocation if, at any time after the filing of the no[ice or Ihe issuance of the certificate, the person named on the notice or <br /> certiFicate no longer mee[s the requirements of this sec[ion for issuance of a certificate. The depar[ment shall revoke a certificate at any time for failure of the person <br /> named on tbe certifica[e to mee[ the requirements oF this sec[ion. <br /> QUESTIONS? (850) 413-1609 <br /> OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 <br /> J�,2 5�6�_ t�.' .. -._.._ - _.._....__STATF OF FLORtt3A . ._...___.__....._. __._..�._._,__�.._ . ..._.. �._..__ <br /> DEPARTMENT OF BLTSII�'�3S.,A�I+'�U PROFFSSTQNAL REGULFiT�ON <br /> ELL�'FR�,CAL, CdNTT�tA.C�`f�RS LI'CTNS'.INC3 BC3AR13 SEQ�L1Q08'254�579 <br /> s L�CTNSE �BR li,:z'.=:= :_<: <br />� �5 2010 10.$Q�48464 EF�O01.3..5�,�:'r �.z%"=N �---.�:��_ '''C';��'� <br /> e ALA�2M SY�Th"'!+�' �41�iTRACT�,'JR 2 f�:>:,��� - '�° <br /> med below IS �BitTIFIED - M= "= '-.,�'; � <br /> der the provisians of Chap�e�:' �. -- ��': � <br /> Piration date: AUG 31 2012 �"`'�''�'•�°" <br /> , ; -��_ � ...� .:�,��:,� <br /> ;�` l. <br /> fi� },�I�i� r�._r$�..— �s' <br /> ^"'��I�..L�ti• -�.: <br /> CLARK, 5T$VEN SCOTT ��°°� ' . <br /> E.A.g. Il+TDUS�RIES INC D�,A A;$.�`,I� r. . ` INC <br /> 4 5'fl0 �LAI�E�TIEW DR `� �� �s; <br /> �` ��,��;:...,. {&�,.,.; <br /> SEBRING FL 33870 x :�-. <br /> CHARLI�:. CRIST C�����. ,��� <br /> GOVLR�TQR SECR$��Y <br /> DfSPLRY�4S REG2UIRED �Y LAW <br />