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06-84-` 1� 11:4� �F�OM-ESSI �1�-9�1-4848 T-835 F���Zi'�4�0� F-655 <br /> i <br /> I <br /> � <br /> JEFF ATWATER $TATE OF FLORIDA ` <br /> CHIEF FINANCIAL OFFICER <br /> DEPARTMENT OF FINANCIAL SERVICES � <br /> DIVISION OF WORKERS'COMPENSATION � <br /> '"CEFiTIFICATE OF ELECTION TO 8E EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW"' ' <br /> NOM-CONSTRUCTION INDUSTRY EXEMPTION <br /> This Ce�tifiES ihat the individual listed below has elected to be exempt from Florid8 Workers'Compensation 18w, � <br /> EFFECTIVE DATE: 5/14/2013 EXPIRA'f10N DAT�: 5/14/2015 � <br /> PERSON: ESTRADA ROG�R <br /> FEIN. 593087069 . <br /> BUSINESS MAME ANU ADDRE88' ' <br /> I <br /> ELECTRONIG SECURITY SYS- f <br /> 9910 N. DALE MABRY HWY ( <br /> TAMPA FL 33614 ! <br /> � <br /> 8COPES OF BUSIMESS OR TRADE: <br /> ELECTRONIC <br /> EQU�PMENT INSTALLAT <br /> pofs�anl lo Chepter C40.05(i o),�.6.,an oKCer of s corporetion wh0 Hecta exemption hom I�is d1Sp�r by rUing a certifiCate af eiecUOn undsr thiS 3CGb+�may � <br /> nol rscover benefla or oompsn3ation unoe�Inis d�apter Pursuent to CAaplsr 44oA5(12).F.3.,Certificats3 of eiectb�tn�e exsmpl.,.bpp�y�ty"+dnin t�s scopE <br /> of ine ousiness w 1lade I�stEa on lns nodce of el�ion Io De exempl,Pu�suanl to Chapter 440.05(13),F.S.,Notices of eleCGO��oe exempt and CeAificales ur <br /> eieclron to be eXemp� s�all be subjec�to revocalion if,d1 e�y��me eiter lha filinq oi l�e no��ce or lne IssuancC of Ihe ceNGcats,lhe pClson namea o�Ihe notics or � <br /> cpn�fcsie no bngsr meets the requiramenls oi mts sedan for iswdnce o1 a cenificate.The depa�mem ea�en r�voke a CeAif�Cate ai any iime lor(ailure oY 1he I <br /> person namEn on the ca�ific9t6 m mee��ne reyuiroments ot mis ssction, ! <br /> i <br /> pF$-F2-DWC-252 CERTIFICAT�OF EI.ECTION TO AE EXEMPT REVISED 07-12 �UES710fdS?(950)d13-1808 <br /> i <br /> i <br />