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<br />., <br /> <br />-------- --- -' - - <br /> <br />i . <br /> <br />A Ii A DRAINAGE Ii VA(: SBRVl:CES :me <br />13846 HW 14TH ST <br />Pl!:l!l1UlOKE PINES, FL 33028 <br />IS I1ROVIDING 1IORlCERS' COMPENSATION 'J!HROUGB <br />FLORIDA CITRUS, BUSINESS & INDUSTRIES FUND <br />POLICY NO. : 39151 <br />EFFECTIVE DATE: 04/01/10 <br />CLAIMS REPRESENTATIVE: <br />UNITED SELF INSURED SERVICES <br />P.O. BOX 616648 <br />ORLANDO, FL 32861-6648 <br />1 (800) 444-9098 . <br /> <br />.' --.- --.-- .._._~_...,---_. -!-..- ~.."'-_: <br /> <br />. I <br />i <br /> <br />'This label contains' important details about your <br />workers' compensation insurance policy. Please. <br />place it overth~' .old sticker o'n th~ wQrkers' <br />compe'1sil.tiQn .("broken arm") poster that you <br />receive~ when you first became insured with <br /> <br />! .;. . <br /> <br />FCBI/FUBA Wor.ker$' .Comp~ You 'are required <br />bylaw..()diSPI~Y th,spost~r at ycjmr place <br />of bUSiness. .. I .. I . ! · <br /> <br />I I 1.,- . <br />I',: . i : <br />i <br />I <br />I <br /> <br />I <br /> <br />,I <br />I <br />l <br /> <br />I . <br /> <br />I <br />I <br />! <br /> <br />I <br /> <br />; r <br />. <br /> <br /> <br />'. I <br />I <br /> <br />I <br /> <br />II. <br /> <br />.:, . i <br /> <br />. ',1'" <br /> <br />~'! " -' ':; , <br /> <br />I ,::' <br /> <br />.. I. <br />1.:1 '" <br />, 'i. ~ . <br /> <br />, , <br />, . <br /> <br /> <br />il ; <br /> <br />I. . <br /> <br />39751 <br />