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Get NY SI-21 2015-2024

__________ Address _________________________________________________________ City, State, Zip Code THIS IS TO CERTIFY that a Workers’ Compensation Excess Insurance Contract has been issued by this Company as follows: The Excess Insurance Contract is now in force and the Company will give the Chair, Workers' Compensation Board, Attention: Office of Self-Insurance, 328 State Street, Schenectady, N.Y. 12305 not less than thirty (30) days written notice of cancellation or of any change to be mad.

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Keywords relevant to NY SI-21

  • occurrence
  • cancellation
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