HomeMy WebLinkAboutCONSTRUCTION INDUSTRY EXEMPTIONVA `
JIMMY PATRONIS
CHIEF FINANCIAL OFFICER STATE OF FLORIDA
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: 8/19/2021
PERSON: KENNETH D WAGNER
FEIN: 475521986•
BUSINESS NAME AND ADDRESS:
4 CORNERS PROPERTY SOLUTIONS, LLC
605 MAGNOLIA STREET
LEESBURG, FL 34748
SCOPE OF BUSINESS OR TRADE:
EXPIRATION DATE: 8/19/2023
EMAIL: 4CORNERSPROPERTYSOLUTIONS@GMAI L.COM
Concrete Construction NOC Carpentry NOC Roofing - All Kinds and Carpentry Dwellings Three
Drivers Stories or Less
IMPORTANT: Pursuant to subsection 440.05(14), 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. Pursuant to subsection 440.05(12), F.S., Certificates of election to be exempt issued
under subsection (3) shall apply only to the corporate officer named on the notice of election to be exempt and apply only within the scope of the business or
trade listed on the notice of election to be exempt. Pursuant to subsection 440.05(13), F.S., notices of election to be exempt and certificates of election to be
exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person 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 on the certificate to meet the requirements of this section.
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13
E01377179 QUESTIONS? (850) 413-1609