|
LEGACY III INSURANCE 401(K)
|
2023
|
264376859
|
2024-09-11
|
LEGACY III INSURANCE AGENCY, INC.
|
9
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2014-02-01
|
| Business code |
524210
|
| Sponsor’s telephone number |
3052560616
|
| Plan
sponsor’s DBA name |
GREAT
|
| Plan sponsor’s
address |
9811 WAYNE AVE, PALMETTO BAY, FL, 33157
|
Signature of
| Role |
Plan administrator |
| Date |
2024-09-11 |
| Name of individual signing |
TAMARA MOURINO |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
LEGACY III INSURANCE 401(K)
|
2021
|
264376859
|
2022-09-30
|
LEGACY III INSURANCE AGENCY, INC.
|
10
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2014-02-01
|
| Business code |
524210
|
| Sponsor’s telephone number |
3052560616
|
| Plan
sponsor’s DBA name |
GREAT
|
| Plan sponsor’s
address |
9811 WAYNE AVE, PALMETTO BAY, FL, 33157
|
Signature of
| Role |
Plan administrator |
| Date |
2022-09-30 |
| Name of individual signing |
TAMARA MOURINO |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
LEGACY III INSURANCE 401(K)
|
2020
|
264376859
|
2021-09-03
|
LEGACY III INSURANCE AGENCY, INC.
|
10
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2014-02-01
|
| Business code |
524210
|
| Sponsor’s telephone number |
3052560616
|
| Plan
sponsor’s DBA name |
GREAT FLORIDA INSURANCE PINECREST
|
| Plan sponsor’s
address |
12745 S DIXIE HIGHWAY, MIAMI, FL, 33156
|
Signature of
| Role |
Plan administrator |
| Date |
2021-09-03 |
| Name of individual signing |
TAMARA MOURINO |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2021-09-03 |
| Name of individual signing |
TAMARA MOURINO |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
LEGACY III INSURANCE 401(K)
|
2017
|
264376859
|
2018-06-25
|
LEGACY III INSURANCE AGENCY, INC
|
8
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2014-02-01
|
| Business code |
524210
|
| Sponsor’s telephone number |
3052560616
|
| Plan sponsor’s
address |
12745 S DIXIE HIGHWAY, MIAMI, FL, 33156
|
Signature of
| Role |
Plan administrator |
| Date |
2018-06-25 |
| Name of individual signing |
TAMARA MOURINO |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2018-06-25 |
| Name of individual signing |
TAMARA MOURINO |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
LEGACY III INSURANCE 401(K)
|
2016
|
264376859
|
2017-07-25
|
LEGACY III INSURANCE AGENCY, INC
|
6
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2014-02-01
|
| Business code |
524210
|
| Sponsor’s telephone number |
3052560616
|
| Plan
sponsor’s DBA name |
GREAT FLORIDA INSURANCE PINECREST
|
| Plan sponsor’s
address |
12745 S DIXIE HIGHWAY, MIAMI, FL, 33156
|
Signature of
| Role |
Plan administrator |
| Date |
2017-07-25 |
| Name of individual signing |
TAMARA MOURINO |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2017-07-25 |
| Name of individual signing |
TAMARA MOURINO |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
LEGACY III INSURANCE 401(K)
|
2015
|
264376859
|
2016-07-11
|
LEGACY III INSURANCE AGENCY, INC
|
6
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2014-02-01
|
| Business code |
524210
|
| Sponsor’s telephone number |
3052560616
|
| Plan
sponsor’s DBA name |
GREAT FLORIDA INSURANCE PINECREST
|
| Plan sponsor’s
address |
12745 S DIXIE HIGHWAY, MIAMI, FL, 33156
|
Signature of
| Role |
Plan administrator |
| Date |
2016-07-11 |
| Name of individual signing |
ANA I MIRANDA |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
