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ipansamopica insurance jmqh
<br />Group
<br />'E1 L1 I - T l A ER 0 PREMIER _J
<br />CERTIFICATE F INSURANCE
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<br />This is to certify that the following described policy or policies have been issued to:
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<br />Location and Remarks:
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<br />. COVERAGES * POLICY NUMBER POLICY PERIOD LIMITS OF-LIABILITY .
<br />Standard Work en' o mpensatjon� Statutory Workmen's Compensation State of .
<br />and Employers' Llabi t . ..
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<br />Automobile Liability€
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<br />This Certificate of Insura nee - does not ar�nend, extend or ar�ter.t e:coverage afforded bar the above policyr s). .
<br />It is the intention of the Company that in the event of cancellation of the- policy or policies by the Company, days written notice of such
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<br />cancellation will be given to you at the address above. d
<br />* '
<br />LK A g gH01 ff �: ri,
<br />614A (12-74)
<br />ORIGINAL
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