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�tw CYQ V <br /> NCACC Risk Management Pools <br /> Workers Compensation <br /> Payment Plan Available: Workers' Compensation Pool Quoted on: 5/18/2021 <br /> County or Entity: LEE COUNTY <br /> Annual Payment Plan: <br /> $408,806 <br /> We appreciate your participation. To insure effective, efficient operation of your Pool we must <br /> receive payment in full no later than August 1st.A two percent late payment fee will be <br /> assessed on all amounts received after that date. <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 v -- A 7 4 64/14-e\- <br /> Print <br /> Title Cc9(1)7 <br /> Date (p - xQ„21 <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 C <br /> Date Lo at-B.1 <br /> Please sign and return the accepted proposal by June 15th, 2021. <br /> NCACC 5/18/2021 <br />