Current through Reg. 47, No. 249; December 28, 2021
(1) Current Self-Insurers shall provide
written notification of changes in the names and addresses, as well as changes
in the structure, of the self-insurer, its affiliates and their wholly or
majority owned subsidiaries, along with the Federal Employer Identification
Number (FEIN), fictitious names, and percentage of ownership for each legal
entity included under the self-insurance authorization within thirty (30) days
of the effective date of the change. Current Self-Insurers shall also provide
written notification of changes in the addresses of all operating locations
with employees within the State of Florida, which are included under the
self-insurance authorization within thirty (30) days of the effective date of
Self-Insurers shall annually provide a written statement of the accuracy of
their subsidiary, affiliate and location information. Such statement shall be
signed by an officer of the Current Self-Insurer.
Notifications of changes and annual
certifications shall be submitted as follows:
Governmental Entities shall submit
location information to the:
Department of Financial Services
Division of Workers' Compensation
Bureau of Monitoring and Audit/Self-Insurance
200 East Gaines Street
Tallahassee, Florida 32399-4224
FSIGA Members shall submit location
information to the:
Florida Self-Insurers Guaranty Association, Inc.
1427 E. Piedmont Dr., 2nd Floor
Tallahassee, Florida 32308
Fla. Admin. Code Ann. R.
FS. Law Implemented
(3), (6) FS.