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CNA CNA PARAMOUNT <br />Policy Holder Notice - Countrywide <br />QUALITY ASSURANCE FORM <br />Help Us To Serve You Better <br />Every effort has been made to produce a quality product for you. Please review this transaction, and if it is incorrect list the <br />correction needed in the space provided below and fax this Quality Assurance Form to us at <br />877-363-8669 or email to ciet@cna.com <br />Questions pertaining to any transaction should be referred to CNA Customer Interaction <br />Center at 877-574-0540, Option 3 <br />Please send routine requests via standard ACORD forms through the same method you are using today. The <br />preferred method is by fax: to 8 7 7 - 3 6 3 - 8 6 6 9 <br />Insured/Account Name: LYRASIS INC <br />Policy Number: C 6017210152 <br />Line of Business: PMT <br />Agent Name: ARTHUR J GALLAGHER RISK MGMT SRV INC <br />Producer Code: 028489 Branch: ATLANTA BRANCH <br />Transaction Type: Renewal <br />Transaction Effective Date: 04/16/2021 <br />Your Transaction was processed by Commercial Insurance Center - Lake Mary, FL <br />C ID: BY CAE6004 <br />Transaction Incorrect - See Below. <br />Correction needed: <br />CNA68757XX 09-12 Copyright CNA All Rights Reserved. <br />Transaction Processed Correctly <br />�ortaN <br />Risk MmWmerdDiMsiun <br />REVIEWED & APPROVED BY. - <br />Risk Management Analyst <br />