CERTIFICATE OF INSURANCE (005)
---..c_
'"
Fl,hRIDA CONSTRUCTION, COMMERCE Ind INDUSTRY
SELF INSURERS FUND
P.O. Box 1616
Sarasota, Florida 33578-1616
12/2f.
DATE
CLEARWATER
IX 4748
ITER
'Ft... 33518
, '~
~..~.:
-i \...
..
~~- ---,--~~'--~_.-.--.~-
tify that: CONSTRCJCTIQNi eQIIlPMf:JW, rMC..
P. o. 80"XI'170
CLEAnSER FL 33517
to the provisions of the Florida \A(orker's Compensation Act,
~t
he payment of compensation by insu:ring their risk with the
'> .>:{
DNSTRUCTION, COMMERQEAND INDUSTRY SELF INSURERS FUND.
~IS SUe..lECT TO CANC1!!l.I::<<n'OH Wl1'tI \:;;J9Io,A'YS NOTICE TO INStJ
3Y: ~Jn(~RX:"'~XW:. FCiC. \C;LlltMS SERY I CE
~ixlil~iWxxxxxxxxx p.o....aox 25248
~~jtlCtxikJ(~i~*xx SARASOTA, FL. 34277-2248
UMBER: 02304 -at
'ATE:t'OI'84
DATE: 12nt'84
Res~c. .1.....I~~bjrit.t~.d.
, ~.,""..-
\
\'
!13 - 01
last year. still with the Fund, will receive refunds of up to 59% of premium, based on GOOD SAFETY EXI