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FWC FLORIDA WORKERS ` COMPENSATION <br /> JOINT UNDERWRITING ASSOCIATION , INC . <br /> P. O. Box 48957, Sarasota , FL 34230- 5957 Tel (941 ) 376-7400 Fax (941 ) 378- 7406 <br /> 12/ 19/2005 app # : 72570 <br /> Effective Date : 12/06/2005 <br /> Binder Number : 2817C618 <br /> EXCHANGE CLUB CENTER FOR THE PREVENTION OF CHILD ABUSE OF THE TREASURE COAST IN <br /> PO BOX 12908 <br /> FORT PIERCE FL 34979 <br /> RE , WORKERS COMPENSATION AND EMPLOYERS LIABILITY BINDER. <br /> ,This is to acknowledge receipt of an estimated or deposit premium payment and your application for coverage <br /> through the Florida Workers' Compensation Joint Underwriting . Association , Inc. ( FWCJUA) . <br /> The FWCJUA is providing coverage under this binder for 30 days, beginning at 12 : 01 a . m . on the effective date <br /> shown above . Coverage is provided under the Workers ' Compensation Law of Florida only. Employers Liability <br /> coverage is also provided subject to the following standard limits : <br /> Bodily Injury By Accident : $ 100, 000 - each accident <br /> Bodily Injury By Disease : $ SOO, 000 - policy limit <br /> Bodily Injury By Disease : $ 100, 000 - each employee <br /> If additional limits were requested, those limits are detailed on the following page. <br /> The policy issued will be written in the name of the Florida Workers Compensation Joint Underwriting <br /> Association , Inc. and services will be provided by the company listed below. <br /> Please retain this binder as evidence of coverage until you receive your policy. <br /> :-r 1 : <br /> COMPANY: <br /> TRAVELERS <br /> P. O . Box 3556 <br /> Orlando FL 32802 <br /> (800) 247-7218 <br /> AGENCY: <br /> CINDY MCCALL <br /> HAYNES & HAYNES INSURANCE <br /> 2222 COLONIAL ROAD SUITE 100 <br /> FORT PIERCE FL 34950- 5309 <br /> (772) 461 -6040 <br /> 2817C618 / 72570 _ _ 1 <br />