HomeMy WebLinkAboutFolio 2024-2026 Permit - CR 663036 CR 663036 - 9/24/2024 j0(6°
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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**
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law.
EFFECTIVE DATE: 1/18/2024 EXPIRATION DATE: 1/17/2026
PERSON: JERRY ZEPATOS EMAIL: ZZEPCO@AOL.COM
FEIN: 461761781
BUSINESS NAME AND ADDRESS:
ZEPCO FENCE INSTALLERS, INC,
LEXINGTON CLUB BLVD SUITE D
DELRAY BEACH, FL 33446
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.
IMPORTANT:Pursuant to subsection 440,05(13),F.S.,an officer of a corporation who elects exemption from this chapter by filing 3 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 tee 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 tenure of the person named on the certificate to meet the requirements of this section,
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT E018401382 QUESTIONS?(650)413-1609
RULE 69L-6.012, A.C.REVISED 0"I2023