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JEFF ATWATER <br />CHIEF FINANCIAL OFFICER <br />STATE OF FLORIDA <br />DEPARTMENT OF FINANCIAL SERVICES <br />DIVISION OF WORKERSCOMPENSATION <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: 10/10/2014 EXPIRATION DATE: 10/9/2016 <br />PERSON: KERNS CHARLES <br />FEIN: 300449688 <br />BUSINESS NAME AND ADDRESS: <br />KERNS CONSTRUCTION AND PROPERTY MGMNT CORP <br />1601 SW HARBOUR ISLES <br />P&T SAINT LUCIE FL 34986 <br />SCOPES OF BUSINESS OR TRADE: <br />LICENSED GENERAL <br />CONTRACTOR <br />Pursuant to Chapter 440.35(14). F.S. an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this secttan <br />may not recover benefits Or compensation under this chapter Pursuant to Chapter 440.05112). F S. Certificates of election to be exempt. apply only <br />within the scope of the business or trade listed on the notioe 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 subiect to revocation if at any time alter the filing of the notice or the issuance of the Certificate. <br />the person named on the notice or certificate no longer meets the reautrements of this section for issuance of a ceraticate. The department shall revoke a <br />OFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 <br />QUESTIONS? 1650)413-1609 <br />