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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 />CONSTRUCTION INDUSTRY EXEMPTION <br />This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. <br />EFFECTIVE DATE: 3/10/2021 <br />PERSON: DONALD G HINKLE <br />FEIN: 592692435 <br />BUSINESS NAME AND ADDRESS: <br />DON HINKLE CONSTRUCTION, INC. <br />246 BIMINI DR <br />FORT PIERCE, FL 34949 <br />SCOPE OF BUSINESS OR TRADE: <br />EXPIRATION DATE: 3/10/2023 <br />EMAIL: DONHINKLE@BELLSOUTH.NET <br />Carpentry NOC Contractor -Project Manager, Carpentry Detached One or <br />Construction Executive, Two Family Dwellings <br />Construction Manager or <br />Construction Superintendent <br />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 <br />this section may not recover benefits or compensation under this chapter. Pursuart to subsection 440.05(l 2), 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 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 />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 <br />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 <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 E01297061 QUESTIONS? (850) 413-1609 <br />