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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 None <br /> Policy Number <br /> Type of Insurance <br /> Claim Number <br /> Settled Amount <br /> Insurance Company Name None <br /> Policy Number <br /> Type of Insurance <br /> Claim Number <br /> Settled Amount <br /> Insurance Company Name None <br /> Policy Number <br /> Type of Insurance <br /> Claim Number <br /> Settled Amount <br /> Insurance Company Name None <br /> Policy Number <br /> Type of Insurance <br /> Claim Number <br /> Settled Amount <br /> - Y _ _ .. - -a,arna:... vsrovwnrw�wwaw..awanr•m..w,w:.-wc m..s.i.asmFaem•w <br /> EVERETT Everett CARES Small Business Grant Program i Round 3 } page 9 <br /> ENE WASHINGTON <br />