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Florida Administrative Code (Last Updated: April 18, 2024) |
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69. Department of Financial Services |
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69L. Division of Workers' Compensation |
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69L-5. Rules For Self-Insurers Under The Workers' Compensation Act |
1Affiliated Self-Insurers must execute a new Form DFS-F2-SI-11 (Indemnity Agreement), effective 08/09, as incorporated by reference, within thirty (30) days of changes in the affiliates included under the self-insurance authorization. Copies of this form are available at the Division of Workers’ Compensation, Bureau of Monitoring and Audit, Self-Insurance S50ection, 2012 Capital Circle, S.55E., Hartman Building, Tallahassee, FL 32399-4224. Form DFS-F2-SI-11 (Indemnity Agreement), effective 08/09, shall be executed by an officer of each affiliated entity to be included under the self-insurance authorization. The executed form shall be submitted to the:
92Florida Self-Insurers Guaranty Association, Inc.
971427 E. Piedmont Dr., 2nd Floor
103Tallahassee, Florida 32308
106Rulemaking Authority 108440.38(1), 109(2), (3), 111440.385(6), 112440.591 FS. 114Law Implemented 116440.38(1), 117(2), (3), 119440.385(1), 120(3), (6) FS. History124–125New 1263-9-10.
