NOTICE OF TERMINATION OF WORKERS COMPENSATION INSURANCE
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For Use of Stale Agency Only
Employer No. I
I
NOTICE OF TERMINATION OF WORKERS' Carrier No.
COMPENSATION INSURANCE
To Assured
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Baker Marine Enterprises, Inc.
56th St. and Maroldy Dr.
Temple Terrace, FL 33687
Fed. Employer ID Number
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59-1467074
Date
November 14,1984
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and the Department of Labor and Employment Security, Bureau of Workers' Compensation,
Tallahassee, Florida 32301. Notice is hereby given in accordance with the proVision of Section
440.42, Florida Statutes, that coverage under our policy number
830-1558
effective
February 14,
84
19 ~, will be terminated as of
December 15,
19
This coverage was originally reported under our policy number
830.,..1558
Very truly yours,
Associated Industries of Florida Self Insurers Fund
(carrier name and address)
P. O. Drawer 988 Lakeland, I; rida 33802
By
RECEJVED~
Karen
NOV 19 1984
cc: Certificate Holders
CITY CLERKi .
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