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SELF INSURERS CERTIFICATE FLORIDt CONSTRUCTION. COMMERCE a.Jt INDUSTRY SELF INSURERS FUND P.O. Box 1616 Sarasota, Florida 33578-1616 12/11 ~ CLEAr.:WA TER )X 4740 ~TER ',:;",:'::: " Vthat:- 'S~ST.~AV);"~ ~; 800.'.~LC)iJ:'i ROAD TARPONSPRtNGS FL 33589 to the provisions of the Florida Worker's Compensation Act, Ie payment of co mpensatiQp by insuring theirri$1< V\iiththe 1:; ~.. . ). L ,i 33518 Of err INSTRUCTION. CO~~~fl9I$AND INDUSTRYSELf INSURERS FUND. IS SUBJECT TO CA~LATION WITH 30 DAYS NOTICE TO INSl , FLORIDA EMPLOYERS INSURANCE SERVICE CORP. P.O. BOX 25248 SARASOTA, FL 34277-2248 813-957-0140 L22 - 01 Respectfu IIBER: 01934 - 01 1/01/87 12/31/87 /J'-'-~ ~ . -+7'7r t~~' ,TE: