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1913 W Edinger Ave - 101118671 & 20182410 - Plan
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1913 W Edinger Ave - 101118671 & 20182410 - Plan
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Last modified
7/31/2025 9:32:48 AM
Creation date
6/9/2025 7:45:01 AM
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Plan
Permit Number
20182410
101118671
Full Address
1913 W Edinger Ave
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E09318CA Page 2 of 13 <br />112016 ed. <br />amount of any deductible for which coverage is demonstrated under another mechanism or <br />combination of mechanisms as specified in 40 CFR 280.95-280.102. <br />c. Whenever requested by a Director of an implementing agency, the Insurer agrees to furnish to <br />the Director a signed duplicate original of the policy and all endorsements. <br />d. Cancellation or any other termination of the insurance by the Insurer, except for non-payment of <br />premium or misrepresentation by the insured, will be effective only upon written notice and only <br />after the expiration of 60 days after a copy of such written notice is received by the insured. <br />Cancellation for non-payment of premium or misrepresentation by the insured will be effective <br />only upon written notice and only after expiration of a minimum of 10 days after a copy of such <br />written notice is received by the insured. <br />e. The insurance covers claims otherwise covered by the policy that are reported to the Insurer <br />within six months of the effective date of cancellation or non-renewal of the policy except where <br />the new or renewed policy has the same retroactive date or a retroactive date earlier than that of <br />the prior policy, and which arise out of any covered occurrence that commenced after the policy <br />retroactive date, if applicable, and prior to such policy renewal or termination date. Claims <br />reported during such extended reporting period are subject to the terms, conditions, limits, <br />including limits of liability, and exclusions of the policy. <br />I hereby certify that the wording of this instrument is identical to the wording in 40.CFR 280.95-280.102 <br />and that the Insurer is licensed to transact the business of insurance, or eligible to provide insurance as <br />an excess or surplus lines insurer, in one or more states. <br />_____________________________________________ <br />Signature of authorized representative of Insurer <br />Douglas Colosky <br />Head of US Operations, Authorized Representative of Lloyd’s Syndicate 623/2623 <br />30 Batterson Park Road, Farmington, CT 06032 <br />1913 W Edinger Ave - <br />101118671 & 201824107/2/2024
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