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Get Ct Commercial Automobile Application 2014-2024

Of $500,000 Combined Single Limits will be subject to a 15 calendar day delay in the effective date as specified in Section 23 of the Connecticut Automobile Insurance Assigned Risk Plan. COMPLETE ENTIRE APPLICATION. SHADED AREAS MUST BE COMPLETED OR NO IDENTIFICATION CARD WILL BE ISSUED AND NO COVERAGE WILL BE AFFORDED. SECTION 1. PRODUCER OF RECORD Producer Last Name/Agency Name Producer First Name MI Mailing Address Ste./Apt. No. Producer License No. Telephone No. (incl. area code) SEC.

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