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<br /> <br />Reply to: <br />~ ADMINISTRATION <br />P. o. Box 20959 <br />Tallahassee. FL 32316-0959 <br />Toll Free (800) 232-5777 <br />(904) 656-7867 <br />Toll Free Fax (800) 315-0124 <br />Fax (904) 878-2451 <br /> <br />CERTIFICATE OF INSURANCE <br /> <br />o CLAIMS <br />P. O. Box 2155 <br />Tallahassee. FL 32316-2155 <br />Toll Free (800) 399-3822 <br />(904) 671-2800 <br />Toll Free Fax (800) 717-7727 <br />Fax (904) 671-2561 <br /> <br />ISSUED TO: <br /> <br />CITY OF A ZEPHYRHILLS, FL <br /> <br />BUILDING DEPT. <br /> <br />This is to certify that HOME TOWN POOLS INC <br /> <br />being subject to the provisions of the Florida Workers/ <br />Compensation Act/ has secured as of the date set forth below <br />workers/ compensation by insuring their risk with the FTBA-Fund. <br /> <br />Policy Number: 890-00001167 <br />Effective Date: 01/01/96 <br /> <br />Statutory-State of Florida <br /> <br />Employers Liability <br /> <br />Expiration Date: 01/01/97 <br /> <br />$ 100/000 (Each Accident) <br />$ 500/000 (Disease-Policy Limit) <br />$ 100/000 (Disease-Each Employee) <br /> <br />This certificate is issued as a matter of information only and is <br />not a policy affording any insurance. Nothing contained in this <br />certificate shall extend/ amend or alter the coverage afforded by <br />the policy shown above or afford insurance to any insured not <br />named above. The insurance afforded by the policy described <br />herein is subject to all terms/ exclusions and conditions of such <br />policy. Should the above policy be cancelled before the <br />referenced expiration date, the certificate holder will not be <br />notified of cancellation. <br /> <br />~'t +~. <br /> <br />Dennis E. Nye/ Administrator <br />FTBA-Fund <br /> <br />December 6/ 1995 <br />