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73![TO: COMMISSIONER OF DEPARTMENT OF FINANCIAL REGULATIONON I certify that the following __________ pages represents a true account of all business done under Surplus Lines Broker’s license #______________ issued under th TO: COMMISSIONER OF DEPARTMENT OF FINANCIAL REGULATIONON I certify that the following __________ pages represents a true account of all business done under Surplus Lines Broker’s license #______________ issued under th](https://www.pdfsearch.io/img/8be01a55b72b8f58089c8895b5361a08.jpg) | Add to Reading ListSource URL: www.dfr.vermont.govLanguage: English - Date: 2012-11-30 08:21:36
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74![NAME & ADDRESS OF: Insured _______________________________________________________________________ Insurance Company _______________________________________________________________________ Brokerage House or Agency NAME & ADDRESS OF: Insured _______________________________________________________________________ Insurance Company _______________________________________________________________________ Brokerage House or Agency](https://www.pdfsearch.io/img/92c5bf668e9c032bd62d568f510cd350.jpg) | Add to Reading ListSource URL: www.dfr.vermont.govLanguage: English - Date: 2012-08-20 07:59:52
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76![Microsoft Word - P&C Rates Checklist.docx Microsoft Word - P&C Rates Checklist.docx](https://www.pdfsearch.io/img/81d2fa395a6f39e66b3762b58961fd59.jpg) | Add to Reading ListSource URL: commerce.alaska.govLanguage: English - Date: 2013-12-17 14:09:03
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77![Homeowners Insurance Forms Checklist.doc Homeowners Insurance Forms Checklist.doc](https://www.pdfsearch.io/img/c64b298b2c79565854f6cc058f63c860.jpg) | Add to Reading ListSource URL: commerce.alaska.govLanguage: English - Date: 2013-12-17 14:09:02
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78![RISC Rice Insurance Services Company, LLC 4211 Norbourne Blvd. Louisville, KY[removed]Phone: [removed]Toll-Free: [removed]Fax: [removed] RISC Rice Insurance Services Company, LLC 4211 Norbourne Blvd. Louisville, KY[removed]Phone: [removed]Toll-Free: [removed]Fax: [removed]](https://www.pdfsearch.io/img/5a856f77f944a72022866800889fc986.jpg) | Add to Reading ListSource URL: www.risceo.comLanguage: English - Date: 2010-03-05 10:34:53
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79![](https://www.pdfsearch.io/img/d4b709e8b0c09c6a5bd791b60c1085a2.jpg) | Add to Reading ListSource URL: www.revenue.ieLanguage: English - Date: 2013-08-02 07:54:10
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80![RISK POOL TIPS AND INFORMATION Determination and Payment of Premium: Your estimated annual premium (the cost of the policy) will be determined based on your estimation of what your payroll will be over a one year period RISK POOL TIPS AND INFORMATION Determination and Payment of Premium: Your estimated annual premium (the cost of the policy) will be determined based on your estimation of what your payroll will be over a one year period](https://www.pdfsearch.io/img/793f9bce94211c17d4edc8bcce423e64.jpg) | Add to Reading ListSource URL: www.oregon.govLanguage: English - Date: 2012-02-02 22:15:05
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