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CALIFORNIA FRAUD STATEMENT <br /> For your protection, California law requires the following to appear on this form: Any person who knowingly <br /> presents false or fraudulent information to obtain or amend insurance coverage or to make a claim for the <br /> payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison. <br /> ILN0180122 <br /> ©Insurance Services Office, Inc., 2021Risk Managementnan <br /> a.� REVIEWED&APPROVED By: <br /> .o. Ac/4 <br /> :immoral, <br /> �� Risk Management Specialist <br />