Laserfiche WebLink
� ext srr <br />•fry apA�t¢tb`• <br />JIMMY PATRONIS <br />CHIEF FINANCIAL OFFICER STATE OF FLORIDA <br />DEPARTMENT OF FINANCIAL SERVICES <br />DIVISION OF WORKERS' COMPENSATION <br />* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW <br />NON -CONSTRUCTION INDUSTRY EXEMPTION <br />This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. <br />EFFECTIVE DATE: 9/17/2019 <br />PERSON: NICHOLAS W CAINE <br />FEIN: 823208787 <br />BUSINESS NAME AND ADDRESS: <br />LIGHT'ER UP LLC <br />137 NE 108TH STREET <br />MIAMI, FL 33161 <br />SCOPE OF BUSINESS OR TRADE: <br />Electric Light or Power Co <br />NOC Ali Employees & Drivers <br />EXPIRATION DATE: 9/1612021 <br />EMAIL: NICK@LI(3HTERUPMIA.COM <br />JIPORTANT- 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 <br />its section may not recover benefits or compensation under this chapter. Pursuant to subsection 440.05(12), P.S., Certificates of election to be exempt Issued <br />nder 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 <br />ade 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 <br />xempt shalt 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 <br />o 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 <br />amed on the certificate to meet the requirements of this section. <br />FS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 E01050744 QUESTIONS? (850) 413-1609 <br />