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<br />REQUEST FOR INSTITta,N~ ~1TFTCATE(Sl <br />To: J. Kessler, Legal Group, WHI Date: /V~Y. ZS , ~~ ~' <br />From: N ~ I~liG~ Z l~.cz K2) ~(~ Job #: I ~ 4- 3 - 01 - I <br />1. Issue insurance certificate(s): ~ General <br />X Professional <br />Have completed the enclosed Certificate of Insurance form(s) provided by the client. <br />~. Enclosed is a copy of the ~nt+ract; <br />3. Brief description of operations. (Identify the project and services,) <br />~~i-~ea +~IaK l~pc1~-f~ <br />4. Start date: ~JeCeu..~~ (q~ I <br />5. Contract duration and fee amount: L~eeew. ~t ~ ~ c Z - ~ g ~ S G, 4 <br />6. Certificate Holder (i.e., Name of client who will recxive certificate.) <br />Name: ~ ~ -~/ o-F ~~ O ~ ~ s-~ <br />Address: 5 z-I-Y~ ~VC r' ~2 t,1.~'C *s • ~c c~ <br />N~(`~c u~'(~s-~e~l c~i(,c~o 44%70 . <br />Attention: l~-cc. ~(~ ~ ~ • ~~n ~ u,~ a N n <br />7. Deliver origins! certiScate(s) to: ~t 't-`I ~ lV Or (~ Q~~ ~-~~ <br />Via: x Fast Class Mail; InterofHcx Mail; Overnight Mail; Fax' <br />(' If requesting fax delivery) Fax No: <br />8. Copy of cxrtificate(s) to: N. Q j~z icc k f'Go <br />9. Note: <br />(Ira. lo~Ol <br />