Board of Employee Leasing Companies
Division of Business and Professional Regulation
2601 Blair Stone Road
Tallahassee, Florida 32399-0767
RE:__________________
Dear________:
Enclosed is a copy of the Certificate of Liability Insurance for ___________________.__________________ is an authorized agent and has the authority to bind coverage with _____________. This policy number is ________, effective from __________ to ________ and issued to ________. This policy provides coverage to leased employees in Florida.
AFFIDAVIT
I, (name of affiant) state:
After having read the above statements, I state they are true and correct to the best of my knowledge and belief.
Fla. Admin. Code Ann. R. 61G7-5.001
Rulemaking Authority 468.522, 468.524, 468.5245 FS. Law Implemented 455.213(11), 455.2281, 468.524, 468.5245, 468.525, 468.526, 468.527, 468.5275, 468.529 FS.
New 5-5-92, Amended 7-15-92, 10-20-92, Formerly 21EE-5.001, Amended 10-24-93, 3-14-94, 7-4-94, 9-8-94, 11-13-94, 2-13-95, 6-4-95, 11-9-95, 5-26-96, 5-19-97, 4-29-99, 9-5-04, 5-29-12, 1-2-13, 2-28-18.