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<br />U~/~~/~UVO u~.~o <br /> <br />.;)U~;lI:J;';~O:JO <br /> <br />l'IIJ\..o'f"~ <br /> <br />",",,,,""" U"YI V..J <br /> <br />. <br /> <br />,'-.,. <br />\) <br /> <br />Affiliating Agreement <br />Page ---L- of ~ <br /> <br />Organization shall furnish a fully completed certificate of insurance signed by an authorized representative <br />of the insurance company providing such coverage. If the Organization is a state agency or subdivision as <br />defined by section 768.28, Florida Statutes. the Organization shall furnish, upon request, written <br />verification of the liability protection in aecordance with section 768.28, Florida Statutes. <br /> <br /> <br />- <br /> <br />q I ~dOh <br /> <br />, <br />\ <br />"- <br /> <br />?t>1t? <br /> <br /> <br />OF MlA:MJ-J)ADE COUNTY, FLORIDA <br />~' <br /> <br />Carolyn Spal'll <br />. of Staff <br />, es (Designee) <br />o ,finl, J,' /' " ' <br />,', , ,~4 J /' ' , , ,\ <br />i1' &1 f ~-i .... I" f\~ j", . .. '-y Ie- ii, <br />l \Chi;;rAd.:;[,,~1~JI~;;;n';~:/L~' 6/ <br />! L' <br />. \ /'1 J <br />1\1 (LAP <br /> <br />Date <br /> <br /> <br />. ;: <br />,1'("; I", /,/ <br />~ ~ / ,_*A . to $;---" <br />f ~ -..I'-_'"'.<'l' 3 <br />i bater ' <br />, ,r <br />. " I, 31 t./ <br />II]: l, .),; <br />'v:<~s <br />/0 hi/OJ, <br /> <br />Date <br /> <br />APPROVED AS TO FORM, <br /> <br />J ~ <br />g{ <br />of: S'~cbOO7B~rd n ey <br /> <br />l\; ([P/61LJ <br />Date <br /> <br />FM-6103 Rev, (02.fl6) <br />