This Certificate-Booklet supersedes and replaces any certificate previously issued.

This Plan Administered

by

FLORIDA ADMINISTRATORS, INC. 7300 N. Kendall Drive

P. O. Box 560695

Miami (Kendall), Florida 33156

Phone:

Miami-665-7441

Broward -525-0612

CLAIMS

For information on how to file a claim, contact the Administrator

RECIPROCAL AGREEMENT

With Other Carpenters Health and Welfare funds Your Health and Welfare Fund has entered into Reciprocal Agreements with other Carpenters' Health and Welfare Funds in Florida. These Reciprocal Agreements may protect you for benefits in the event a claim is denied under the Eligibility Rules of this Fund and/or the Eligibility Rules of other Fringe Benefit Funds which have received contributions made on your behalf.

If you submit a claim which has been denied and you have worked for another Carpenters' local in Florida which has received contributions made on your behalf, you should contact Florida Administrators, Inc.

CERTIFICATE OF INSURANCE

THE FARMERS NATIONAL LIFE INSURANCE

COMPANY

Certifies to Insure Certain Members of the Broward County Carpenters'

HEALTH AND WELFARE FUND

Ft. Lauderdale, Florida
Under Their Group Policy

No. FNL-GRP 205

This booklet will constitute your Certificate of Insurance after you receive your Certificate of Coverage. As the Certificate of Insurance, it HEREBY CERTIFIES that (A) the employee and his dependents, if any, whose application is on file at the office of the Trustees, whose name is endorsed herein, and for whom the required premium has been paid, are insured under and subject to all the exceptions, limitations and provisions of said group policy for the benefits described herein; (B) benefits will be paid in accordance with the provisions and limitations of said ordinary group life policy to the beneficiary designated by the Insured Employee in writing on the application filed at the office of the Trustee; and (C) The Farmers National Life Insurance Company has issued and delivered to the Trustees the above specified group policy insuring certain employees and their eligible dependents, if any. This individual Certificate is furnished in accordance with and subject to the terms of said group policy and is merely evidence of insurance provided under said group policy which insurance is effective only if the employee is eligible for insurance and becomes and continues insured in accordance with the terms, provisions and conditions of said policy.

WHEN THE EMPLOYEE BECOMES INSURED FOR THE GROUP BENEFITS DESCRIBED HEREIN THE CERTIFICATE OF COVERAGE ISSUED TO HIM MUST BE AFFIXED IN THE SPACE PROVIDED ON THE BACK COVER AND THIS BOOKLET THEN BECOMES HIS BOOKLET-CERTIFICATE.

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