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Florida Municipal Insurance Trust
<br />i
<br />Third Installment Billing - 22/23 Fund Year
<br />FLORIDA MUNICIPAL_ INSURANCE TRUST
<br />FMIT li 0079 Invoice Date:
<br />311/2.023
<br />Bank ACII: Capital City Bank
<br />'General Liability Coverage
<br />$53,456.75
<br />($11,226.00) $42,230.75
<br />Cyber Liability Coverage
<br />217 N. Monroe St.
<br />$0.00 $840.00
<br />Invoice ID N: INV•37710•NU7 Duo
<br />Date:
<br />111/7.023
<br />Tallahassee, FL 32301
<br />$10,837,00
<br />_
<br />($2,709,00) $8,128.00
<br />Property Coverage
<br />$51„023,50
<br />RTN#/ABA#:063100688 ACCT1t:0032620701
<br />Workers Compensation Coverage
<br />ATTN: Andy Brooks
<br />($13,719.75) $54,893.75
<br />Total Installment Amount $171,394.25
<br />Acct Type: Chocking
<br />City of Casselberry
<br />Acct Name: Florida Municipal Insurance Trust
<br />95 Triplet Lake Drive
<br />Please make chock payable to:
<br />Cassolborry, FL 32707
<br />Florida Municipal Insurance Trust
<br />P,O, Sox 1757
<br />Tallahassee, I'L 32302.1757
<br />,
<br />General
<br />Cyber
<br />Auto
<br />Auto Physical property Workers'
<br />Total
<br />Liability
<br />Liability
<br />Liability
<br />Damage Comp,
<br />Gross Premium $213,627
<br />$3,360
<br />$76,151
<br />$43,348 $204,094 $274,454
<br />$815,234
<br />Incentive Credit ($44,904)
<br />$0
<br />($19,038)
<br />($10,836) $0 ($54,879)
<br />($129;657)
<br />Total Net Premium $168,923
<br />$3,360
<br />$57,113
<br />$32,512 $204,094 $219,575
<br />$685,577
<br />Previous Invoices
<br />$342,788.50
<br />Payment Received On 9/6/2022
<br />($171,394,25)
<br />Payment Received On 12/14/2022
<br />($171,394.25)
<br />Total Balance Forward
<br />$0.00
<br />Coverage
<br />Tile g'
<br />Premium
<br />Incentive credit Total Net premium
<br />'General Liability Coverage
<br />$53,456.75
<br />($11,226.00) $42,230.75
<br />Cyber Liability Coverage
<br />5890.00
<br />$0.00 $840.00
<br />Auto Liability Coverage
<br />$19,037,75
<br />($9,759.50) $14,278.25
<br />Auto Physical Damage Coverage
<br />$10,837,00
<br />_
<br />($2,709,00) $8,128.00
<br />Property Coverage
<br />$51„023,50
<br />$0,00 $51,023.50
<br />Workers Compensation Coverage
<br />$68,613.50
<br />($13,719.75) $54,893.75
<br />Total Installment Amount $171,394.25
<br />rotas Due by 4/1/2023 $171,394.25
<br />NOTE: Any change In premium from the previous Installment is due to endorsements) to your policy. These endorsements are available to you
<br />on the EMIT website: http://insuranre,flcities.com
<br />Please see below for a copy of our Premium Installment Plan, Penalty Polity and ACH Instructions.
<br />Plezrse return es copy W this invoico A(h your payrn3nt_to lh . Y W ah:l, �,, s± uftiei, or sand Aril irlornr:ztiorr, Inv;iit�: Numt�:zr
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