Laserfiche WebLink
�� „ �q <br /> �x � �; 03-03-2011 <br /> �-, ,,,� <br /> :�.,�� <br /> �EFF ATWATER STATE OF FLORIDA <br /> CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES <br /> DIVISION OF WORKERS' COMPENSATION <br /> * * CERTIFICATE OF EIECTION 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: 03/03/2011 EXPIRATION DATE: 03/02/2013 <br /> PERSON: GOVER GREGORY <br /> FEIN: 273089912 <br /> BUSINESS NAME AND ADDRESS: <br /> 2G CONTRACTING SERVICES LLC <br /> 7550 MT LAUREI DR <br /> ZEWiYRHILLS FL 33540 <br /> SCOPES OF BUSINESS OR TRADE: <br /> 1- MAINTENANCE 2- DRYMALL <br /> IMPORTANT Pnrsr�ni ro Ch�pte� 140 D51NI, F 5. u otlicer ot ■ csrpornio� w�o elects eremption Irow �his c6�p�er by lili�g a ceniliu�e el elac�ia� nMer tAis <br /> sectios eay not recorer �eeefi�s or cempensstioe aeder tAis cAspter P��sr�nt lo CMpler It0 051I21, F.S. Certilinles ol electien to be e�e�pl. apply a�ly witYia the <br /> scope of tMe b�einess or tnlr lis�d en Ihr noti�e ol electroe �o �e e:ewpt. Prrs��at to CY�pter 440.05(131, F.S., Metices ot eietlion to be exempt ��� [ertil�ntes ol <br /> Nen�on to be exesp� sh�ll be suD�ect [o rovocalioa il a� any tiAe fier !Ae liling ol t�e emice or t6e ist���ce ot Ihe certiliutr, tAe person n�med oa �he aotice or <br /> cenifiu�e no longer weris ��e tequiremenis ol IAis secFto■ Im issnaace ot a �eitilic�te TAe /eput�enl sMdl reroie � certific�lp a( �py ti�ne tor tulure ol I�e person <br /> es�ed on the canitiu�e �o Teri M� requirewe�ls of Ihis sec�ion. <br /> QUESTiONS? (8501 4 t 3-1609 <br /> �WC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVI$EQ 07-11 <br /> PIEASE CUT OUT TME CARD BELOW AND RETAIN FOR FUTURE REFERENCE <br /> STATE OF FLORIDA IMPORTA�IT <br /> DEPARTMENT OF flNANC1AL SERVICES <br /> ����K�''���� F Pursuant to Chapter 440.05114), F.S., an nf f icer of a corporation who <br /> CONSTRLIC'TION II�lJSTRY �elects exemption from this chepter 6y filing a certificate of election <br /> CERTIFICATE OF ELECTION TO BE FJCEMPT FROIYI FLORIDA L under this section msy not recover benef its or compensation uoder this <br /> WORKERg COMPENSATION U►W D Chapter. <br /> EFFECTIVE: 03/03/2011 EXPIRATION DATE: 03/02/2013 pursusnt to C <br /> PERSON: GREDORY GpVER H heDter 440.05ft21, f.S., Certifiutes of election to be <br /> exempt.. apply only within the scope of the busmess or trode listed on <br /> FEll�t 2 7 30889 1 2 R the notice of election to be exempt. <br /> BUSINESS NAME AND ADDRESS: E Pursuant to Chspter 44U.051131. F.S., Notices of tiection to be exe t <br /> 2G CONTRACTING SERVICES lLC �V � <br /> ar►d certiticates of election fo be exempt shsll be subject ta revocation <br /> �sso M� �auRe� oa if, st any Ume after the filing ot the notice or the isswnce of the <br /> ZEPHVRN�US Fi 335aI: CCf11fICa[E, the person named on the notice or certiticate no longer meets <br /> the requirements of this section for issu�ce of e certificete. The <br /> department shsll revoke e certificate at any ame for failure of the <br /> SCOPE OF BUSINESS OR TRADE: person named on the cernficste to meet the requirements af this ? <br /> t- MAINTENANCE 2 DRYWRL: SCCIIO(1. <br /> QUESTIONSi 1850) 413-1609 <br /> CUT HERE <br /> � Carry bottom portion on the job, keep upper portion fo� your racords. <br /> �WC-252 CERTIFICATE Of EIECTION TO BE El(EMPT REVISED 01-11 <br />