Lead painter

EFFECTIVE DATE:

PERSON:

BUSINESS NAME AND ADDRESS:

DAYGORO SANTOS

GORGEOUS PAINTING AND MORE LLC

**** ** * ***

PORT SAINT LUCIE, FL 34953

FEIN:

JIMMY PATRONIS

CHIEF FINANCIAL OFFICER STATE OF FLORIDA

DEPARTMENT OF FINANCIAL SERVICES

DIVISION OF WORKERS' COMPENSATION

* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * IMPORTANT: Pursuant to subsection 440.05(13), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to subsection 440.05(11), F.S., Certificates of election to be exempt issued under subsection (3) apply only to the corporate officer named on the notice of election to be exempt. Pursuant to subsection 440.05(12), F.S., notices of election to be exempt and certificates of election to be 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 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 named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT RULE 69L-6.012, F.A.C. REVISED 01/2023

E01805775 QUESTIONS? 850-***-****

CONSTRUCTION INDUSTRY EXEMPTION

10/10/2023 EXPIRATION DATE: 10/9/2025

932780156

EMAIL: ad5puz@r.postjobfree.com

This certificate of election to be exempt is NOT a license issued by the Department of Business and Professional Regulation. To determine if the certificate holder is required to have a license to perform work or to verify the license of the certificate holder, go to www.myfloridalicense.com. This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.

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