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Fort Walton Beach Council agenda — 02-26-13--regular — reading text
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A Workers COmpemation and
Employers' LlabIMy
WC 71949 01101) 2013 01/ 012016
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Lion Insurance CO rry is A. M. Beat COmParty rated A- ( Excellent). AM$ 912616
Deacdptlons of Opera6omelLaoadOns( VeNbbe(EStlWbns added by Endwsecent/Swchil Provbbro: Clentro: 8165 -895
Caemge Only app4es b adM e111pbyee{ s) mSODU Fes Employee leadn9 Sykes, Inc. mM ett leased m the rdunwb9 " Llent Cnmpa, ry':
III N Such Nenre, Tne dba WI SaMS Development
Coverage onh appnes to Injudm barred by Soud, Eau pusorray t¢adn9. Inc. & Subddbhe acdPe empbyeos) , while working In Florida.
Coverage does not appty to epMU'y empo ne ( s) or Indep¢MNI conbaMr(s) of the dent Company or any other eeky.
A Ikr of me acoW empbyee( s) MW to de Client Company can be obtained by her, a vacua# b (T27) 9P -2138 or by calling ( T27) 93R 556L
Protect Name:
INCLUDES USL & H. FAX. 850-314-0445J ISSUE 02 -29 -12 SO) ReBHW 1210112 ISHI I REISSUE 02 -12 - 13 ( rD)
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LERTFCATE HOLDER CA4CELLAIM
CITY OF FORT WALTON BEACH a nl MPNwtlrwlW r4 e. PCaaymaia Mnmtbee M
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PO. BOX 4009
FORT WALTON BEACH, FL 32549 AQ
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STATE OF FLORIDA
EXPIRES SEPTEMBER 3U, 2 d1
d-
TYPEOF.
INES /
CONTRACTOR -
ROOMS SEATS
GENERAL CONTRACTOR
EMPLOYEES 2
SUPPLEMENTAL
RENEWAL
R
d
NEWSLSINESS
SUSIN,rSS 1
TRANSFER
BUSINESS 2 MAPLES ST
ORIGINALW
ADDRESS FORT
RT WALTON BEACH, FL 32548 0. 00
OKALOOSA COUNTY
18. 00 '
Taz Collector
MA. cnecxs PAYAaLETO- Okaloosa County lax Collector AMOUNT 0. 00'
PO. Box 13871 Niewille, FL325811-
PENALTY
0, 12005310 0. 00
COLLECTION COST
08/ 29/ 2012
DECKS N SUCH MARINE INC
Paid 18. 00
TOTAL 18. 00'
DECKS N MARINE INC
P O BOX' 32 7,
Fr WALTON BEACH, FL ' 32549
X
SIGN AND DI$ PLAY AS, PEOUIRED
I sWEARTHATTHS LOCALsUSINES8TAx RECEIFT IB MADE FOR