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1 � ^o� <br />N o � Ir i 1 C .A a o t, r N A <br />AssoctATloNF OF COUNTY C ONINISS(ONERS <br />24 i <br />NCACC Risk Management Pools <br />Worker's Compensation <br />Payment Plan Available: Workers' Compensation Pool Quoted on: 4/1212011 <br />County or Entity: LEE COUNTY <br />Annual Payment Plan: (due on or before August 1, 2011) <br />$310,890 <br />I understand that changes made to the exposures subsequent to submission of the <br />renewal application may result in changes to the Estimated Contribution: <br />Accepted by: <br />Signature <br />Printed Name John A. Crumpto <br />Print Title County Manager <br />Date <br />This instrument has been pre- audited in the manner required by the Government Budget and Fiscal Control <br />Act. <br />Financial Officer: <br />Signature <br />Date <br />NCACC 4/12/2011 <br />