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<br />'="- <br /> <br /> <br />05-08-2007 <br /> <br />ALEX SINK ST ATE OF FLORIDA <br />CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES <br />DIVISION OF WORKERS' COMPENSATION <br /> <br />* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * <br />"CONSTRUCTION INDUSTRY EXEMPTION <br /> <br />This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. <br /> <br />EFFECTIVE DATE: <br /> <br />05/08/2007 <br /> <br />EXPIRATION DATE: 05/07/2009 <br />RIGOBERTO SR <br /> <br />PERSON: RUIZ <br /> <br />FEIN: 205405629 <br /> <br />BUSINESS NAME AND ADDRESS: <br />B & G FENCES CORP <br />9905 NW 116 WAY <br />#109 <br />MIAMI FL 33178 <br /> <br />SCOPES OF BUSINESS OR TRADE: <br />1- FENCE ERECTION <br /> <br />IMPORTANT: pursuanl to Chapter 440 . 0&(14), F.S., an olticer 01 a corporalion who elects exemption Irom this chapter by Iiling a certilicate 01 election under this <br />section may not recover benefits or compensation under this chapler. pursuant to Chapter 440.0&(12), F.S., Certilicates of election to be exempt... apply only within the <br />scope 01 the business or trade lisled on the notice 01 election 10 be exempt. pursuanl 10 Chapler 440.0&(13). F.S., Nolices 01 election to be exempl and certificates 01 <br />election to be exempt shall be subject to revocation ii, at any time alter Ihe tiling 01 Ihe notice or Ihe issuance 01 the certilicate, the person named on Ihe notice or <br />certilicate no longer meets Ihe requirements 01 this seclion lor issuance 01 a certilicate. The department shall revoke a cerlitieate at any time lor failure 01 Ihe person <br />named on the certificate to ~eet the requirements ot this section. <br /> <br />QUESTIONS? (SSO) 413-160 <br /> <br />DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06 <br />