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the municipal secretary desktop reference manual - Southwestern ...

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INSURANCE REGISTER*<br />

Type of Coverage ___________________________________________________<br />

___________________________________________________<br />

Term<br />

________________________________________________________<br />

Agent/Broker<br />

_______________________________ Company ___________<br />

Address ___________________________________________________________<br />

Policy No. ______________________________________________<br />

Annual Premium _________________________________________<br />

FACE VALUE $ _________________________________________<br />

Premium charged to Account No. _________________________________<br />

Increase/Decrease in coverage over previous year? ________________________<br />

_________________________________________________________________<br />

Any significant changes in exposure over previous year? ______________________<br />

_________________________________________________________________<br />

_____________<br />

*Adapted from a Guide Book For Local Government: Risk Management, State of Illinois,<br />

Department of Local Government Affairs, no date.<br />

XIV-19

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