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<br />FRSA-SIF 'Above the Rest' <br /> <br />.. <br /> <br /> <br />P.O. BOX 4907- WINTER PARK. Fl.32793- (407) 671-FRSA <br />1-800-767-3772- FAX (407) 671-2520 <br /> <br />CERTIFICATE OF INSURANCE <br /> <br />ISSUED TO: <br /> <br />COPY PROVIDED TO: <br /> <br />Pasco County Bldg. Dept. <br />13852 17th St. <br />Dade City FL 33526 <br /> <br />Alan's Roofing, Inc. & Adco <br />Construction, Inc. <br />329 W. Jefferson Street <br />Brooksville FL ;S4601 <br /> <br />ATTN:To whom it may concern <br /> <br />Date: 05/30/2002 <br /> <br />This is to certify that <br /> <br />Alan's Roofing, Inc. & Adco Construction, Inc. <br />329 W. Jefferson Street <br />Brooksville FL 34601 <br /> <br />being subject to the provisions of the Florida Workers' Compensation Act, has secured the payment of <br />compensation by Insuring their risk with the FLORIDA ROOFING, SHEET METAL & AIR CONDITIONING <br />CONTRACTORS ASSOCIATION SELF INSURERS FUND. <br /> <br />COVERAGE NUMBER: <br /> <br />870-033049 <br /> <br />L1MlTIi . <br />Workers' Compensation Statutory - State of Florida <br /> <br />01/01/2002 <br /> <br />EFFECTIVE DATE: <br /> <br />Employers' liability <br /> <br />$100,000 - Each Acddent <br />$100,000 - Disease, Each Employee <br />$500,000 . Disease, Policy Limit <br /> <br />EXPIRATION DATE: <br /> <br />01/01/2003 <br /> <br />REMARKS: Non-cancelable without 30 days prior written notice. <br /> <br />This certificate is not a policy and of itself does not afford any insurance. Nothing contained in this c:ertificate shall be <br />constructed as extending coverage not afforded by the policy(ies) shown above or as affording insurance to any <br />insured not named above. This provides coverage for Florida policyholders and Florida domicile employees only. <br /> <br />~~ <br /> <br /> <br />Tom Drake, Administrator <br />FRSA-SIF <br /> <br />By: <br /> <br />~~ <br /> <br />Debbie Kemmerer - SIF Accounts Repres.mtatlve <br />FRSA-SlF <br />