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488-6603 Fax 850. 487-9622 Ken Lawson Secretary Rick Scott Governor FLORIDA FARM LABOR REGISTRATION AND TESTING WORKERS COMPENSATION INFORMATION Workers Compensation Coverage Provided by Contractor s Employer Name of Contractor/Corporation Social Security or License Number Street Rural Route or Post Office Box City State and Zip Code Effective this date I NAME ADDRESS AND PHONE NUMBER OF EMPLOYER will pay the premium for Workers Compensation Insurance on you and your crew members as long as yo ...

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