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Please provide information regarding any insurance policies and information regarding claims filed and paid,if any,in the designated <br /> spaces below.If no claim was filed under an insurance policy listed below,fill in the applicable blank with"None." <br /> Insurance Company Name l_thtri illogiu 2.-i <br /> 1 <br /> Policy Number U2- .Z qi-' lie e/7.5-3 freme. <br /> Type of Insurance Prop.eel i <br /> Claim Number A417)e- 1 <br /> 1 <br /> Settled Amount i <br /> AO n e- <br /> t , <br /> Insurance Company Name ii.h.er"1 /170,A0t,/ <br /> Policy Number 7-16 at - Zi. i*9 i4 *4.13 i-tig D <br /> Type of Insurance 11AL i iete <br /> t <br /> I Claim Number <br /> i- NO-176 <br /> i Settled Amount <br /> C.,, <br /> Insurance Company Name g <br /> I <br /> Policy Number <br /> Type of Insurance <br /> Claim Number <br /> Settled Amount <br /> Insurance Company Name <br /> Policy Number <br /> I <br /> Type of Insurance <br /> i <br /> Claim Number 1 <br /> Settled Amount <br /> i'm EVERETT a: Everett CARES Small Business Grant Program I Round 3 i page 9 <br /> WASIONGICIN <br />