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PL-16-2206Protect Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Parcel Number Expiration: 02/21/2017 Applicant 1561 NE 103 Street Miami Shores, FL 33138- 1132050310220 Block: Lot: M2J4 HOLDINGS LLC Owner Information Address Phone CeII M2J4 HOLDINGS LLC 1561 NE 103 Street MIAMI SHORES FL 33138- (786)290-8051 660 NW 125 Street NORTH MIAMI FL 33168- Contractor(s) Phone CeII Phone BLUE DOLPHINECONSTRUCTION LLt (954)605-1418 Valuation: Total Sq Feet: $ 4,727.10 0 Type of Work: 2 BATHROOMS 1 KITCHEN AND WATER HEA Type of Piping: Additional Info: Bond Return : Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Notary Fee Permit Fee Scanning Fee Technology Fee Total: Amount $3.00 $3.38 $3.38 $1.00 $5.00 $225.00 $3.00 $4.00 $247.76 Pay Date Pay Type Invoice # PL -8-16-60891 08/25/2016 Check #: 1118 $ 247.76 $ 0.00 Amt Paid Amt Due Available Inspections: Inspection Type: Top Out Final Review Plumbing Underground In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constructi • and zoning. Futhermore, I authorize the above-named contractor to do the work stated. A thorized Signature: Owner / Applicant / \ ,tractor / Agent Building Department Copy August 25, 2016 Date August 25, 2016 1 BUILDING PERMIT APPLICATION Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 F�c-� IVIS AUG 8 2 ZOle 3`x'(1 FBC 20(4 Master Permit No. 12-G /IL �� 03 Sub Permit No. PI (4) — 9a0k BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: ) 5 1 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: �1�2_, 46 n3 / _'Q 2Z 0 Is the Building Historically Designated: Yes NO Occupancy Type: ad: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): tivxZit KO . Address: ( L 6( 1J'e i e3 S t �- 4ione#: City: ` l P l""k' S Ci! OCI S State: Tenant/Lessee Name: Email: L1e-. �Sr%iC . Cv,.t+-1 CONTRACTOR: Company Name: T)1.0E Pn; tArt`r�-ok (40) -ii 4 )( -o-4 Address: '37 «,..) 'ft tl City:C v� ti {tp State:—;` Qualifier Name: C'� _ 1�ta`y Row'. c State Certification or Registration #: 2 4,ck g DESIGNER: Architect/Engineer: Address: City: Zip: 3 3, t 33 Phone#: VC- "2 -Cu WS Phone#: 6WSWi X0235 t4{ {r$ Zip: 3`375 2 Phone#:( k) a fW{� f Certificate of Competency #: Phone#: State: Zip: Value of Work for this Permit: '/, 2-9. 1°Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace la A ✓vd.fra f I )C. . Description of Work: 114 res /(V"D<.1 cre5 ❑ Demolition Specify color of color thru tile: 2.0 CCF $ 3 • CO/CC $ 38 DBPR $ 3 35 Notary $ s. Submittal Fee $ Scanning Fee $ '00 Technology Fee $ Structural Reviews $ P Permit Fee $ Radon Fee $ (Revised02/24/2014) Training/Education Fee $ (.03 .410 Double Fee $ Bond $ g TOTAL FEE NOW DUE $ 2 i • Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature OWNER or AGENT The foregoing instrument was acknowledged before me this efrl day of *.rd y , 20 no , by /V4fi14 L L 444 hi4 / , who is personally known to me or who has produced as identification and who did taken oath. NOTARY PUBLIC: C_. Sign: k --/C7.5 C>1 Seal: Signature 4 CONTRACTOR The foregoing instrument was acknowledged before me this day of ��1 ,20 1 (, ,by (€� (i� `(tAixr� ,who is personally known to me or who has produced �� 1 1 L as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: t ,- DAMAYIVEGA : s MY COMMISSION # FF 214016 Via: EXPIRES: April 1, 2019 ************** sipgjjilt�tk*+iiMMlibia oetbiag* ****************** APPROVED BY yel (Revised02/24/2014) Plans Examiner Structural Review u rA t -\--"\A D O r'e l t' Y1 JUDITH DORELIEN MY COMMISSION #FF031954 I„FOFnoQ. EXPIRES June 27, 2017 tom `• 1i ****o'i r'irmta*ry ervt*ce Com **” ** IP* ******* Zoning Clerk BLUE DOLPHIN CONSTRUCTION LLC 8932 SW 49TH STREET COOPER CITY FL 33328 PPHONE 954 6051418 CFC1428488 DATE: 8/3/16 STATE OF FLRIDA COUNTY OF BROWARD BEFORE ME THIS DAY PERSONALL APPEARD CESAR RUMICHE WHO, BEING DULY SWORN AND SAYES THAT HE WILL BE THE ONLY PERSON WORKING ON THE PROJECT LOCATED AT 1561 NE 103 ST MIAMI SHORES, FL 33138 SOWRN TO AND SUBSCRIBED BEFORE ME THIS OF-Si20-1-10BY PERSONALLY KNOW OR PRODUCED IDENTIFICATION -------------------- TYPE OF IDENTIFICATION PRODUCED-- --L-i - JUDITH DORELIEN MY COMMISSION #FF03*953 EXPIRES June 27, 2017 FloridallotaryServlce,com Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor, part-time employees or subcontractors for your pro'ect. The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In - e circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from - contractor's company for day labor, parttime employees or subcontractors. BY SIGNING BEL n W YOU ACKNOGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: State of Florida Owner County of Miami -Dade The foregoing was acknowledge before me this Oto day of LI-exem No : 1111\ By SEAL: 20 11e who is personally known to me or has produced as identification. ,ire, rt; . DAMAYI VEGA _.. ;:: MY COMMISSION @ FF 214016 EXPIRES: April 1 2019 �i6°�• Bonded Thar Notary Public Underwrites ACORO® CERTIFICATE OF LIABILITY INSURANCE 40....---- DATE(MM/DD/YYYY) 07/19/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Pascal Burke Insurance Agency P.O. Box 8537 Newport Beach, CA 92658 CONTACT Pascal Burke NAME: PHONE 877-893-7629Ne);FAX 855-646-0304 ADDRESS: insure@pmaxins.com INSURER(S) AFFORDING COVERAGE NAIL 0 INSURER A : United Specialty Insurance Company 12537 INSURED Cesar Martin Rumiche Blue Dolphin Construction, LLC 8932 S.W. 49th St. Fort Lauderdale, FL 33328 License No. CGC1509201 INSURER B : SII 1003804744-01 INSURER C: 08/21/201b INSURER D : $ 1,000,000 INSURER E: $ 50,00( INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIR TYPE OF INSURANCE N'SR SUBR POLICY NUMBER EFF (NNDDIYYYYI M/DCY SW �D(YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY Y SII 1003804744-01 08/21/2015 08/21/201b EACH OCCURRENCE $ 1,000,000 DAMAGES ( RENTED PREY cea gyres $ 50,00( CLAIMS -MADE X OCCUR n) MED EXPXPs MED (My one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES )--11 POLICY n JECT PER: LOC PRODUCTS - COMP/OP AGG $ 1,000,000 $ AUTOMOBILE UABIUTY ANY AUTO AU. OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per acddent) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAR EXCESS UAB — OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes describe under DESCRIPTION OF OPERATIONS below , ! N N / A WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POUCY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, B mono space Is requked) ALL LOCATIONS AS REQUIRED BY WRITTEN CONTRACT. BLANKET ADDITIONAL INSURED ENDORSEMENT IS INCLUDED. /\ CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department 10050 NE 2 Av. Miami Shores, FL 33138 ACORD 25 (2010/05) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2014 THROUGH SEPTEMBER 30, 2015 DBA: Business Name: BLUE DOLPHIN CONSTRUCTION LLC Owner Name: CESAR MARTIN RUMICHE Business Location: 8932 SW 49 ST FT LAUDERDALE Business Phone: 954-605-1418 Rooms Seats Employees 1 Receipt #:PLUM INC/LWN SPRNKL/CONTRACTOR Business Type: Business Opened:05/01/2006 State/CountylCert/Reg:CFC 14 2 84 8 8 Exemption Code: Machines Professionals For Vending Business Only Number of Machines: Vending Typa: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 2.70 0.00 0.00 29.70 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT WHEN VALIDATED Mailing Address: CESAR MARTIN RUMICHE 8932 SW 49 ST COOPER CITY, FL 33328 This tax is levied for the privilege of doing business within Broward County and is non -regulatory in nature. You must meet all County and/or Municipality planning and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. 2014 - 2015 Receipt #03A-14-00000203 Paid 10/09/2014 29.70 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2015 THROUGH SEPTEMBER 30, 2016 DBA: Business Name:BLUE DOLPHIN CONSTRUCTION LLC Owner Name: CESAR MARTIN RUMICHE Business Location: 8932 SW 49 ST FT LAUDERDALE Business Phone: 954-605-1418 Rooms Seats Employees 1 Receipt#:Type:PLUM ING/LWN SPRNKL/CONTRA Business Business Opened:05/01/2006 State!Cou nty!Cert/Reg:c FC 14 2 8 4 8 8 Exemption Code: Machines Professionals For Vending Business Only Number of Machines: Vending Tvoe: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 2.70 0.00 0.00 29.70 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non -regulatory in nature. You must meet all County and/or Municipality planning and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. WHEN VALIDATED Mailing Address: CESAR MARTIN RUMICHE 8932 SW 49 ST COOPER CITY, FL 33328 2015 - 2016 ®1RtidRfl t':'`ffi111fT1f'iC`�1i ,ol��11F�.''_ .r'` =� �� Receipt #30B-15-00000106 Paid 10/06/2015 29.70 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 RUMICHE, CESAR MARTIN BLUE DOLPHIN CONSTRUCTION, LLC 8932 SW 49TH ST COOPER CITY FL 33328 Congratulations! With this license you become one of the neariy one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and leam more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, IS CERTIFIED under the provisions of Ch 489 FS. and congratulations on your new license! Expiration date AUG 31 2016 L1408280002405 (850) 487-1395 STATE OF FLORIDA ,,rjr, DEPARTMENT PROFESSIONAL REGULATION BUSINESS AND CFC1428488 ISSUED: 08/28/2014 CERTIFIED PLUMBING CONTRACTOR RUMICHE, CESAR MARTIN BLUE DOLPHIN CONSTRUCTION, LLC DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER CFC1428488 The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 RUMICHE, CESAR MARTIN BLUE DOLPHIN CONSTRUCTION, LLC 8932 SW 49TH ST COOPER CITY FL 33328 ISSUED: 08/28/2014 DISPLAY AS REQUIRED BY LAW SEQ # L1408280002405 Report Viewer 100% Page 1 of 1 JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS COMPENSATION * * CERTIFICATE OF ELE9TION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW* • CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed bekAV has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 6/16/2014 EXPIRATION DATE: 8/15/2016 PERSON: RUMICHE CESAR M FEIN: 200583431 BUSINESS NAME AND ADDRESS: BLUE DOLPHIN CONSTRUCTION LLC 8932 SW 49 ST. COOPER CITY FL 33328 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL LICENSED PLUMBING CONTRACTOR CONTRACTOR Pursuant to Chaster 440.00(14). F.S., an officer at a corpoestiat mho elects esenptian from 88 b0810oao 118election 0ree of sneer ads encase may not remee recover o this e dialers. Paerenlm Chapler440.05(12), F.8, d to be aemp-. apply only Veen 80 scope d the business n hada Wed at the mike at election la be attempt Pumrent to Chapter 440.05(13). P.S.. Nelms of denim to be exempt earl medicates d election to be attempt shall be e8(ea to hso*t00 t. at any Mere after aro Ong of the notice mem 11000800 e1 the waters are panne named on the mace a m>a60*N no ions meal Me requirements at Oda seamter isseranco ofa . The deportment shot resoles a certifkatea any time for Eva ate peens named on the canteens le mea the requirements ones seam. DFS-F2-OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (850)413.1609 httos://aons8.fldfs.com/crrenortviewer/retiortViewer.asnx?data=kdvniinc9D7O3 eH6TER6... 6/17/2014 JEFF ATWATER 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: 6/15/2016 EXPIRATION DATE: 6/15/2018 PERSON: RUMICHE CESAR M FEIN: 200583431 BUSINESS NAME AND ADDRESS: BLUE DOLPHIN CONSTRUCTION LLC 8932 SW 49 STREET COOPER CITY FL 33328 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL LICENSED PLUMBING CONTRACTOR CONTRACTOR Pursuant to Chapter 440.05(14), 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 Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), 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 DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609