HomeMy WebLinkAboutAGG Workers Comp Exemption CertificateEFFECTIVE DATE:
PERSON:
BUSINESS NAME AND ADDRESS:
CLIFFORD M ULLMANN
AGG PRESERVATION LLC
7704 18TH AVE NW
BRADENTON, FL 34209
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
QUESTIONS? (850) 413-1609E01668037
NON-CONSTRUCTION INDUSTRY EXEMPTION
2/9/2023 EXPIRATION DATE:2/8/2025
841763476
EMAIL:CLIFF@AGGRESTORATION.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.