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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: 7/26/2021 <br />PERSON: CHRISTOPHER M NEUMANN <br />FEIN: 474619258 <br />BUSINESS NAME AND ADDRESS: <br />EAGLE EYE OFFICIATING LLC <br />9160 N.W. 25TH STREET <br />FORT LAUDERDALE, FL 33322 <br />SCOPE OF BUSINESS OR TRADE: <br />Athletic Spods or Park: <br />Operation 8 Drivers <br />EXPIRATION DATE: 7/2612023 <br />EMAIL: EAGLEEYEOFFICIATING@YAHOO.COM <br />IMPORTANT: Pursuantto 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 />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 <br />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 <br />trade listed on tie notice of election to be exempt Pursuant to subsection 440.05(13), F.S., notices of efecton to be exempt and certificates of election to be <br />exempt shall be subjeotto revcoatfon ifi, at anytime after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate <br />no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for falfure of the person <br />named on the certificate to meet the requirements of this section. <br />DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 E01356900 QUESTIONS? (850) 413-1609 <br />