CERTIFICATE OF INSURANCE (032)
014
FLORltA CONSTRUCTION, COMMERCE and I~DUSTRY
SELF INSURERS FUND
P.O. Box 1616
Sarasota, Florida 33578-1616
~
12.1'0,'84
DATE
CITY OF CLEARWATER
TO: A TfN: C I TV' A TTORNFY
P.O. 3!.JX 4714:8
CLEARWATER
.,,,.....,,
f RECEIVED
.
DEe 10 1984
t~ITY CLERK
,
This is to certify that: LINOt"SOWF,;1'oILrc
364 S-..l!iT H\.iYE .:i .
S T P~'f1! R~lJURGiiiifi
, -,-,",:'-"<-,':
FL .,~t 4
,.:'_::.,':' ' , ' , "-,-,
being subject to the Provisionsof't~eFlorida W.orker's Compensation Act,
has secured the payment of compensation by insuringth~ir risk with thai.
, ',,,: "',:.>,
FLORIDA CONSTRUCTION, COMMERCE AND INDOSTRYSSIJF1J\JSURi.RS FUND.
COVERAGE IS SUB.lECT TO CANCEu:."rIO""ITHi"O~~~' NOTICE TO I'4SURED
SERVICED BY: F.C.C.!. Claims Service . .......
P.O. Box 25248
Sarasota, FL 34277-2248
AGENT: 00332 - at
Respectfully submitted,
COVERAGE NUMBER: 00716 - 01
EFFECTIVE DATE: 1'01 J"f\5
EXPIRATION DATE:IZ'31.l'85
~~
;3~
F .C.C.1. members last year, still with the Fund, will receive refunds of up to 59% of premium, based on GOOD SAFETY EXPERI ENCE.