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945 49TH ST <br />ERO BEACH FL 32957 <br />COPES OF. BUSINESS OR TRADE: <br />LANDSCAPE GARDENING <br />i <br />DRIVERS <br />%tursuarit to Chapter 410.05(14), F.S., an officer cf acorporation who elects exemption from this chapter by filing a certificate of e:ectior. under this section <br />ay not recover benefits or compensation under this chapter. Pursuant to Chapter 4.40.05(121. F.S., Certificates of election to be exempt... apply only <br />thin the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be <br />exempt and certificates of election to be exempt shall be subject to revocation at any time after the filing of the notice or the issuance of the certificate, <br />tate person named on the notice or certificate no longer meets the requirements of this secii0n for issuance of. a certificate. The department shall revoke a <br />CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (650)413-1609 <br />iriva fi�g'` <br />JEFF ATWATER <br />CHIEF FINANCIAL OFFICER <br />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 />ONSTRUCTION INDUSTRY EXEMPTION <br />This certifies that the individual listed below has <br />elected to be exempt from Florida Workers' Compensation law. <br />EFFECTIVE DATE: 6/11/2016 <br />EXPIRATION. DATE; 6/11/2018 <br />PERSON: SEMBLER <br />CHARLES W 11 <br />FEIN: 204350940 <br />BUSINESS NAME AND ADDRESS: <br />SOUTHERN MANAGEMENT. LLC <br />945 49TH ST <br />ERO BEACH FL 32957 <br />COPES OF. BUSINESS OR TRADE: <br />LANDSCAPE GARDENING <br />i <br />DRIVERS <br />%tursuarit to Chapter 410.05(14), F.S., an officer cf acorporation who elects exemption from this chapter by filing a certificate of e:ectior. under this section <br />ay not recover benefits or compensation under this chapter. Pursuant to Chapter 4.40.05(121. F.S., Certificates of election to be exempt... apply only <br />thin the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be <br />exempt and certificates of election to be exempt shall be subject to revocation at any time after the filing of the notice or the issuance of the certificate, <br />tate person named on the notice or certificate no longer meets the requirements of this secii0n for issuance of. a certificate. The department shall revoke a <br />CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (650)413-1609 <br />