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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 N/A <br /> Policy Number N/A <br /> Type of Insurance N/A <br /> Claim Number N/A <br /> Settled Amount N/A <br /> Insurance Company Name <br /> Policy Number <br /> Type of Insurance <br /> Claim Number <br /> Settled Amount <br /> Insurance Company Name <br /> Policy Number <br /> Type of Insurance <br /> Claim Number <br /> Settled Amount <br /> Insurance Company Name <br /> Policy Number <br /> Type of Insurance <br /> Claim Number <br /> Settled Amount <br /> AffINIINON <br /> 1: WVE RETT WASHINGTON Everett CARES Small Business Grant Program : Round 3 page 9 <br />