WORKER'S COMPENSATION EXEMPTION. i
Reuben Clarson Consulting, Inc.
972-31 st Ave. N.E.
St.Petersburg, Fl. 33704
Ph. 727-895-4717
Fax 727-895-4717
Florida Licensed Engineer # 16313
Certificate of Authorization #9206
August 17, 2������
City of Clearwater
Attention: City Clerk AUG 2 0 20i2
P.O. Box 4748
Clearwater,F1. 33758-4748 �a Fl�i,+�. R����$ ��
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Re: Reuben Clarson Consulting insurance certificate submittal
for Engineer of Record (marine) contract with City
Dear City Clerk:
I am having the certificates for required liability and E+O sent to you by the agencies. I
am enclosing a copy of my Worker's Compensation exemption for your files.
If there are any questions please call. Thank you for the opportunity to be of service.
Sincerely,
Reuben Clarson Consulting
r`` "�r,(.��---- C' ���._.�—
Reuben Clarson
Florida Licensed Engineer 16313
• i
STATE OF FLORIDA �
DEPARTMENT OF FINANCIAL SERViCES
DIVISION OF WORKERS' COMPENSATION
NON—CONSTRUCTION INDUSTRY - �
I CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA a�wv�
I WORKERS' COMPENSATION LAW
EFFECTIVE: 10/18/2010 EXPIRATION DATE: N/A
PERSON: REJBEN CLARSON
FEIN: 030434387
BUSINESS NAME AND ADDRESS:
REUBEN CLARSON CONSUITING INC
972 31ST AVENUE NE
SAINT PETERSBURG, FL 33704
SCOPE OF BUSINESS OR TRADE:
t- ENVIRONMENTAL CONSULTWG