69L-5.213. Subsidiary, Affiliate and Location Reporting

(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 the change. (2) Current 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. (3) Notifications of changes and annual certifications shall be submitted as follows: (a) Governmental Entities shall submit location information to the: Department of Financial Services Division of Workers’ Compensation Bureau of Monitoring and Audit/Self-Insurance 1579 Summit Lake Drive Tallahassee, FL 32317 (b) FSIGA Members shall submit location information to the: Florida Self-Insurers Guaranty Association, Inc. 1427 E. Piedmont Dr., 2nd Floor Tallahassee, Florida 32308