New FORM Request For Certificate Of Insurance
User Manual: New-FORM-Request-for-Certificate-of-Insurance
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Request for Certificate of Insurance Please complete and forward to Council office: Fax: 717.394.7776 or email: Leishamarie.rivera.org Complete Shaded Areas Certificate Holder (Organization/Business) Organization/Business: Contact Name: Address: City, State Zip: Contact Telephone: Contact Email: Contact Fax Number: Amount Needed: Unit Type and Number: Start Date: End Date: Purpose: Requestor Information Name Telephone Email 630 Janet Avenue, Suite B-114, Lancaster, PA 17601 (717) 394-4063 Fax: (717) 394-7776
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File Type : PDF File Type Extension : pdf MIME Type : application/pdf PDF Version : 1.6 Linearized : Yes Author : Karen Glover Company : Created : D:20170119 Create Date : 2018:02:23 10:44:58-05:00 Last Saved : D:20180222 Modify Date : 2018:02:23 10:46:51-05:00 Source Modified : D:20180223154443 Has XFA : No Language : EN-US Tagged PDF : Yes XMP Toolkit : Adobe XMP Core 5.4-c006 80.159825, 2016/09/16-03:31:08 Metadata Date : 2018:02:23 10:46:51-05:00 Creator Tool : Acrobat PDFMaker 11 for Word Document ID : uuid:843ece86-c261-4298-9e6b-f8a174fa85e3 Instance ID : uuid:a709fe16-46be-4123-8d34-edc090e3d097 Subject : 4 Format : application/pdf Creator : Karen Glover Producer : Adobe PDF Library 11.0 Page Layout : OneColumn Page Count : 1EXIF Metadata provided by EXIF.tools