1987/2007 (12)THE STATE INSURANCE FUND
199 CHURCH STREET NEW YORK, N.Y. 10007
(212) 312-7249
CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
TOWN OF WAPPINGERS FALLS
WAPPINGERS FALLS NY 12590
POLICY NUMBER
-~ g53 156-7
DATE
9/20/91
CERTIFICATE NUMBER
:::,:F?EFt10D:: ~(7VEFtEfl:.:&1':.:THI;S:::CERI'IFI~{x'1'E .:...::.:..::::
1:~!~:0?:1.89.::T17;:1.D.1. i 4% 91 .:.:..:::....:.
CERTIFICATE HOLDER
POLICYHOLDER
TOWN OF WAPPINGERS FALLS
.TACKALYN BOYLE D/B/A WAPPINGERS FALLS NY 12590
AMERICAN ROCK EXCAVATING
106 REEVES STREET
GLEN PK, WATERTOWN NY 13601
THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER
NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 10/14/91.
THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF
INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY
ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER.
CANCELLATION
THE STATE INSURANCE FUND
~, Co~
DIRECTOR, INSURANCE FUND UNDERWRITING
5li5
THE STATE INSURANCE FUND
199 CHURCH STREET NEW YORK, N. Y. 10007
(212) 312-7249
CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
TOWN OF WAPPINGERS FALLS
WAPPINGERS FALLS NY 12590
POLICYHOI DFR
F?EFZIOD:; CO:VEREfl:: 61!:::THIS:::CERTIFIC~1'fE ::::::::::::::::
JACKALYN BOYLE D/B/A
AMERICAN ROCK EXCAVATING
106 REEVES STREET
GLEN PK, WATERTOWN NY 13601
POLICY NUMBER
'` 953 156-7
DATE
9/20/91
CERTIFICATE NUMBER
890-891
CERTIFICATE HOLDER
TOWN OF WAPPINGERS FALLS
WAPPINGERS FALLS NY 12590
THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER
NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 10/14/91.
THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF
INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY
ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER.
CANCELLATION
THE ST-A~TiE INSURANCE FUND
~9` . C~~
DIRECTOR, INSURANCE FUND UNDERWRITING
544
THE STATE INSURANCE FUND
199 CHURCH STREET NEW YORK, N.Y. 10007
(212) 312-7249
CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
TOWN OF WAPPINGERS FALLS
WAPPINGERS FALLS NY 12590
RERIOD:;~(7V;ERED:;:B1~:.:THI.S:::C~RT~FI,LATE ::::::.:.:::.:.:.:::
i x:1:0? 189::T17::10:l 1 ?~1:~1:::::
pni Ic'YHN_ nFR
JACKALYN BOYLE D/B/A
AMERICAN ROCK EXCAVATING
106 REEVES STREET
GLEN PK, WATERTOWN NY 13601
POLICY NUMBER
'' 953 156-7
DATE
9/20/91
CERTIFICATE NUMBER
890-889
CERTIFICATE HOLDER
TOWN OF WAPPINGERS FALLS
WAPPINGERS FALLS NY 12590
THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER
NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 10/14/91.
THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF
INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY
ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER.
CANCELLATION
THE ST-A~TiE INSURANCE FUND
DIRECTOR, INSURANCE FUND UNDERWRITING
546