HomeMy WebLinkAboutConstruction Industry Exemptionit • rj;6" 11
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JEFF ATWATER STATE OF FLORIDA
CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
* CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE: 12/19/2011
PERSON: FOSTER
FEIN: 371653026
BUSINESS NAME . AND ADDRESS:
PAUL A FOSTER INC
7241 SE MAGELLAN LN
STUART FL 34997
SCOPES OF BUSINESS OR TRADE:
1- ELECTRICAL/ ELECTRICIAN
EXPIRATION DATE: 12/18/2013
PAUL A
i
I
IMPORTANT: Pursuant to Chapter 440 . 0504), F-s., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this
section may not recover benefits or compensation under this chapter. Personal to Chapter 440.05112), F.S., Certificates of election to be exempt... apply only within the
scope of the business. or trade listed on the notice of election to .be exempt. Pursuant to Chapter 440.05113), F.S., Notices of election to be exempt and certificates of
election to be exempt shall he subject to revocation it. at any time after the filing of the notice or the Issttance of the certificate, the parson named on the notice or
certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person
named an the certificate to meet the requirements of this section. QUESTIONS? (850) 413-1609
OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11
AC#5 9.9:9 5:9-5
STATE OF FLORIDA..>,
34997
RICK:: SCOTT;'.`;.
GOVERNOR ...
DISPLAY' AS REQUIRED BY-LAW
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KEN LAWSON
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