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Insurance Certificate: Peterson Machinery Co.
ruouutouut e ` E. , OREP , CERTIFICATE OF LIABILITY INSURANCE 0i ors200220 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS M CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES Li. BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED N REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. w. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must have.ADDITIONAL INSURED provisions or be endorsed. `V If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CA LIC 0B29370 1-925-798-3334 CONTACT Susan J. Peragallo cc Edgewood Partners Insurance Center (EPIC) PHONE FAX '^ [Concord - Branch ID 15469] (A1C.No.Extt 925-822-9033 (pIC Ne);925-609-5366 AI P.O. Box 5668 ADDRESS: susan.peragallo@epicbrokers.com LU INSURER(S)AFFORDING COVERAGE NAIC N Concord, CA 94524INSURERA:NATIONAL UNION FIRE INS CO OF PITTS 19445 INSURED INSURERS:LEXINGTON INS CO 19437 Peterson Machinery Co. INSURERC:NEW HAMPSHIRE INS CO 23841 Peterson Holding Company P.O. Box 5258 INSURER; INSURANCE CO OF THE STATE OF PA 19429 INSURER E: San Leandro, CA 94577 INSURER F: COVERAGES CERTIFICATE NUMBER:58915735 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS .INSD WVD POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) A X COMMERCIALGENERALLIABILITY X X 0L5268175 04/01/20 04/01/21 EACHOCCURRENCE $ 2,000,000 DCLAIMS-MADE X OCCUR PREM SES Ea occurrence) $ 500,000 MED EXP(Any one person) $ Excluded PERSONAL&ADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE _$ 4,000,000 POLICY X JECT I I LOC PRODUCTS-COMPIOPAGG $ 4,000,000 OTHER: $ A AUTOMOBILELIABILITY X X CA4489668 04/01/20 04/01/21 (EOOe accident)MBINEDSINGLELIMIT $ 5,000,000 _ X_ ANY AUTO _ _ BODILY INJURY(Per.person)- $_ _ -- - - - OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS _ _ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _AUTOS ONLY (Per accident) $ B X UMBRELLALIAB X OCCUR 80877677 04/01/20 04/01/21 EACHOCCURRENCE $ 4,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 4,000,000 DED RETENTION$ $ WORKERSCOMPENSATION X PER OTH- C X WC015893698 - CA ONLY 04/01/20 04/01/21 STATUTE ER AND EMPLOYERS'LIABILITY Y/N D ANYPROPRIETORIPARTNERIEXECUTIVEWC015893697 - Other State84/01/20 04/01/21 E.L.EACHACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? n N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 Ryes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remade Schedule,may be attached If more apace Is required) RE: All Contracts/Written Agreements between the Certificate Holder and the Insured. Additional Insured(s): City of Ashland, Oregon, its officers, agents and employee°. where required by written contract per policy form attached. GL and Auto coverage is Primary and Waiver of Subrogation applies per the attached where required by contract per policy form. WC Waiver of Subrogation Applies for California if required by written contract per the attached policy form. CERTIFICATE HOLDER CANCELLATION Account #1044350 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 90 N. Mountain Ave. AUTHORIZED REPRESENTATIVE • Ashland, OR 97520 $...02---- ---- G I USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SofiaOcegueda 58915735 YJZUVU2UUU2 z o r DATE SUPPLEMENT TO CERTIFICATE OF INSURANCE 03/30/2020 NAME OF INSURED: peters= Machinery Co. co Peterson Holding Company O Additional Description of Operations/Remarks from Page 1: cv W Additional Information: SUPP(05/04) roznuunuu2 POLICY NUMBER: rGi X2$81 5 ` q�ar :.44. COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 0 ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS 00 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Operations Or Organization(s) - "1NY PERSON OR Ot GANIZATION WHOM YOU3 BECOME ,x;' 'PER THE CONTRACT OR fAGREEMENT�." . ' '€' nFx� va°`vs su s"P, "-fir ^z rt 't �t z+ Y'.. Y}f t 'avF td tr�`'-Xgxn4 OBLIGATED TO INCLUDE'AS°AN ADDITIONAL INSURED AS, &,Z a `� vow " '�, x 410446,;$4, y � # s s t � c x s RESULT O stANY COAGt EEMENT YOU HAVE ENTEFIED�INTO "Rj, �£ � i� ,�� * r�� 4�`0` a dz �s€`�� ,Pza�..``r n' ,��,v-f�r`���� �4 t.€, �, '''a.�z � � h t h ¢ e F ti s x .� ,3- x r sv wiz�: ZS " iii r r t f i 'f N z aV P C S -a t - ,� ,s§ .�.k 3 f 3 z3' ru wsi# s 'u`" r 4 s M f5�'k s..i"{�" v i ti r'�z` ¢ h, v� i et9` T -Y`% ^'s-r5€ e'd ,#i`$ h 5��22''` ,,�? -g,,,k! t 4#4 �` f'^. z #i, T,: dt f 2� �S i v✓PYY"`V Y a$'LF � � �" 'D�9` '9'r.,,-0,A.::,�`` v�'4A.&R sx-WW-1 .hrai-;..;" x�5a, ,'x.W..x. u':',!''.,. , : : �" u �c m::,f r,mvaw_ ��_.�c oa. Y Information required to complete this Schedule, if not, shown above, will be shown in the Declarations. - -A. Section II - Who Is An Insured is amended to - -- .. which- you are required-by- the contract or - include as an additional insured the person(s) or agreement to provide for such additional organization(s) shown in the Schedule, but only insured. with respect to liability for "bodily injury" or B. With respect to the insurance afforded to these property damage caused, in whole or in part, additional insureds, the following is added to by "your work" at the location designated and Section III - Limits Of Insurance: described in the Schedule of this endorsement If coverage provided tothe additional insured is performed for that additional insured and required by a contract or agreement, the most included in the "products-completed operations we will ,pay on behalf of the additional insured hazard". is the amount of insurance: However: 1. Required by the contract or agreement; or 1. The insurance afforded to such additional 2. Available under the applicable Limits of Insu- insured only applies to the extent permitted rance shown in the Declarations; by law; and whichever is less. 2. If coverage provided to the additional . This endorsement shall not increase the appli insured is required by a contract or agree- cable Limits of Insurance shown in the Decla- ment, the insurance afforded to such addi- rations. tional insured will not be broader than that CG 20 37 04 13 ©Insurance Serivces Office, Inc. 2012 Page 1 of 1 P5260028002 POLICY NUMBER: G( 12'52,0134 1 °' is COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. o ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS 00 This endorsement modifies insurance,provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) - Location And Description Of Completed Operations Or Organization(s) rt "S x av x £ :x ,..,,5ax h a R ANY PERSON OR ORGANI A�ION WHOM',YOU.1IBECOME# '� PERT E CONTRACT OF AGREEMENT." 4-ti o,V OBLIGATED TO INCLUDEA SAN ADDITIONAL INSURED ASA ' ` fiF0 f % � „ � 3 f C P! 4 � 7 '��f as 1 fP ,R ifeWt,*s �, � x �F 16 x.4 x 10 e i 1, i °V•ti , i Ir "' RESULT OF ANY CONT to SSIt AG i EMENT`YOU H V ��•. t ._ �'� � � ✓ £ Ya,� � 4�u: EN 'ERED INTs� u t x�fc t Y id r�� 4L } 4 a 4 f 2� ,. �s�w,K-*'��.s�»"�x I ` 2" .. a 7 .x a nA'ks-t•y,a `"e evs a ``, €'a' s. r 3 r�a`' Es ra 1 s:.g.! y,,,:: ,x d c 'G,,. -.0 „.� b w" Y x �. S fia x¢ �"'t� �h�f ' �. i r k�w tF!"�fi�, c*3'� � , ._ ti`"+�.`����".'� '� tr ��w,� " r�,a � � +t ,� ; ti i� x :s ��'�� � � �s� �5" f £ r -4 de. , S t1 � 4 f �• . `+'n `e `....f, ,.. ..r r.„� t.. asap �T... ',.a,.r!'?< ,-,vv z .;g Information required to complete this Schedule, if not shown above, will 'be shown in the Declarations. A. Section II - Who Is An Insured is amended to which you are required by the contract 'or include as an additional insured the person(s) or agreement to provide for such additional organization(s) shown in the Schedule, but only insured. with respect to liability for "bodily injury” or B. With respect to the insurance afforded to these property damage caused, in whole or in part, additional insureds, the following is added to by "your work" at the location designated and Section III - Limits Of Insurance: described in the Schedule of this endorsement If coverage provided to the additional insured is performed for that additional insured and required by a contract or agreement, the most included in the "products-completed operationswe will pay on behalf of the additional insured hazard". is the amount of insurance: However: 1. Required by the contract or agreement; or 1. The insurance afforded to such additional 2. Available under the applicable Limits of Insu- insured only applies to the extent permitted rance shown in the Declarations; by law; and whichever is less. 2. If coverage provided to the additional This endorsement shall not increase the appli insured is required by a contract or agree- cable Limits of Insurance shown in the Decla- ment, the insurance afforded to such addi- rations. tional insured will not be broader than that CG 20 37 04 13 olnsurance Serivces Office, Inc. 2012 Page 1 of 1 P52600281102 POLICY NUMBER: roDz88VPM4, g" � 111111- COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 0 PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION 00 z This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance policy provided that: Condition and supersedes any provision to the (1) The additional insured is a Named Insured contrary: under such other insurance; and Primary And Noncontributory Insurance (2) You have agreed in writingin a contract This insurance is primary to and will not or agreement that this insurance would seek contribution from any other insurance be primary, and would not seek contribu- available to an additional insured under your tion from any other insurance available to the additional insured. CG 20 01 04 13 °Insurance Serivces Office, Inc. 2012 Page 1 of 1 P5260028002 r ` ' COMMERCIAL GENERAL LIABILITY POLICY NUMBER: y� �2������ z ,� t�� � ; x� CG 24 04 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. oa ` n O . WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US 00 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: ,� UR e�r.*a, - �` r rr t s s ti" '. thavt A r � I� .CA i W_r r lu aNTR r of lw trrt�r Y"oft ER �vT ,✓ y�rx�� . r � F �.v^. ,A�,A ,feet 3 �1 ��� 5 S ..5�� � "^ � L i4 T� � ����d�,.F'Y�,y��'S� � ..Lh Y'Y•.+w?� G' '£'Y ...yyrf- �C j � 3" ��.. y.�fi r rh, - r 4krr < rr3ssrv Dep �s7 ✓,, /('N , 1' -r e#' V-Vgi�� ��,� . u S*"n'aa. r �:�✓a -a` � r�a?"iK .�. r �aw. x ^r , N: ?"`� '`'1 y ,3W#,,," �:,yt t „�.n�T'�sv'z, u ' &� � � £ r r :a��,^��o � � tri [ I _t s k" ':_r a 'i �.� a"'' "k, e, '$� � &'�e L.,4`� 1 y,,: u� zy 'i e " 3 .�, <.�a�� �ez5.�}, ,.wr%r�,.�s�m.�a„� i :i,Ri�;� , ,s��' .a�. �-��s ,� ,.�.,, ,v�.,v.C- .aSi K Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Sec- tion IV- Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing opera- tions or "your work" done under a contract with that person or organization and included in the products-completed operations hazard'. This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 Insurance Services Office, Inc., 2008 Page 1 of 1 recuoucnuut • ENDORSEMENT This endorsement, effective 12:01 A.M. V4 211202Ct: ;` ' ' forms a part of �„ Tr�i 3$��Vii' �'wr e. ��-� r �r+ � =r -�^r`� �x�� �5�,� ��' � PolicyNo. CA 4489668 u., ,� cs 7� 7 rn issued to Peterson Holden Com any 4K � M :. M.. a,< sa ,w:� a. .. � tea. : _. 0 by (yatinalf.UrIor F. re Insurance,G_pAp e►y µf 1?ftts ai i l?A Ge Ge THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - WHERE REQUIRED UNDER CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SCHEDULE ADDITIONAL INSURED: f"SA'N1 PERSON 0071414 ANfZATId'(V ihO*WHOM 01,0 CO3RW�TUAI�LY£BOIf,ND O PROVIDE ADDITI OIU iNSU�RED,�STATU`S*R 1T ONL0'4O'THE(,EXTl NT A,.S, SUCI�i�,PE,JSO,N'S OR„QRGANIZ TIONS L(ABIL11 V`ARIS1NGdUT t 4 ,d' c`rt"".='..a`" `h "Ca'' Y"g „�8, .�"k-�fSE" tL,. ,, x xa��`'G7isti t }t`.aT,, ,' ,. „'�`r�i.:`�"5.`^'��'$ s0��^^ t OF A Cc)VERED :U010 u 2 � _ �`VAVA „ k �tWy� h61 i fs u7 rt' r , .i a a .moi li2"9 s. .3{ ' �3 k 4v40 ,,'� r k,,� ?r �x r4 �d . �77 ,,�� �� � Jx. §"a � 'fid t �E ? ��§ � a P t +• i ist_._....sw,.�;,.d:E?.`..._.`.:".:. z i&,0 2.S 4,14,4k t...:s rs� ttiliatf.c:�: z aigl:.`.E"ret^t _a ZA b :,1Aliag.A _..x2163A-1,« 4A,1 I. SECTION II - COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1. - Who Is Insured, is amended to add: d. Any person or organization, shown in the schedule above, to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of use of a covered "auto". However,the insurance provided will not exceed the lesser of: (1) The coverage and/or limits of this policy, or (2) The coverage and/or limits required by said contract or agreement. AUTHORIZED REPRESENTATIVE 87950 (9/14) Includes copyrighted information of Insurance Services Office, Inc., Page 1 of 1 with its permission. ENDORSEMENT This endorsement,effective 12:01 A.M. 0�9 6i@17 forms a part of 0 policy No. CA4489668 issued to PETERSON HOLDING COMPANY, ET AL 1-- by by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. INSURANCE PRIMARY AS TO CERTAIN ADDITIONAL INSUREDS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM Section IV - Business Auto Conditions, B., General Conditions, 5., Other Insurance, c., is amended by the addition of the following sentence: The insurance afforded under this policy to an additional insured will apply as primary insurance for such additional insured where so required under an agreement executed prior to the date of accident. We will not ask any insurer that has issued other insurance to such additional insured to contribute to the settlement of loss arising out of such accident. All other terms and conditions remain unchanged. Authorized Representative or Countersignature (in States Where Applicable) 74445 (10/99) Page 43 ENDORSEMENT w This endorsement, effective 12:01 A.M. reiarlfgaSiiigiaglalforms a part of 1^�� Y� "�sv"�'b ,� �.�� c � .a^-^�. s1�p �zCs^ Y .r def*"` � ;t"' ,.�� Policy No _CA14$9,�6 $ SME.s� .� I issued to EPet�rstaltr�JI �tmp" n `� nI By gatikirigrior„ ir nsdfigae coana 'far9grA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM Section IV - Business Auto Conditions, A. - Loss Conditions, 5. - Transfer of Rights of Recovery. Against Others to Us, is amended to add: However, we will waive any right of recover we have against any person or organization with whom you have entered into a contract or agreement because of payments we make under this Coverage Form arising out of an "accident" or"loss" if: _ _ _. _ _ - (1) The "accident" or "loss" is due to operations undertaken in accordance with the contract existing between you and such person or organization; and (2)The contract or agreement was entered into prior to any "accident" or "loss", No waiver of the right of recovery will directly or indirectly apply to your employees or employees of the person or organization, and we reserve our rights or lien to be reimbursed from any recovery funds obtained by any injured employee. . Authorized Representative 62897 16/95) P526UU28UU2 ENDORSEMENT oa n BLANKET WAIVER.OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following"attaching clause"need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 04/01/2020 forms a part of Policy No. WC 158-93-698 Issued to Peterson Holding Company By New Hampshire Insurance Company We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not enforce our right against any person or organization with whom you have a written contract that requires you to obtain this agreement from us,as regards any work you perform for such person or organization. The additional premium for this endorsement shall be 2.00%of the total estimated workers compensation premium for this policy. WC 04 03 61 (11/90) P526UU2WU2 • ENDORSEMENT WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. ,11 (The following"attaching clause"need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM .04/01/2020 forms a part of Policy No. WC 0158.93=697 Issued to Peterson Holding Company By Insurance Company of the State of Pennsylvania We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule.This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule ANY PERSON OR ORGANIZATION TO WHOM YOU BECOME OBLIGATED TO WAIVE YOUR RIGHTS OF RECOVERY AGAINST, UNDER ANY WRITTEN CONTRACT OR AGREEMENT YOU ENTER INTO PRIOR TO THE OCCURRENCE OF LOSS. This form is not applicable in California,Kentucky,New Hampshire,,New Jersey, North Dakota, Ohio,.Tennessee,Texas, Utah,or Washington. , WC 00 03 13 (4/84) v Countersigned by Authorized Representative V 2ODUenwz Edgewood Partners Insurance Center(EPIC) P.O.Box 1668 Concord,CA 94524 202004013914 Electronic Service Requested EB I X BPO 0 MIXED AADC 975 ~ 5872 1.6405 MB 0.436 I'11111111111111111.1111111111111u1u11111.1111111nIHliii.111111 .11 City of Ashland 139 90 N MOUNTAIN AVE ASHLAND, OR 97520-2014 This document was brought to you by CertificatesNow. - If you have questions regarding the content of this document, - please call (800)234-6363 and ask for Susan Peragallo.- For new certificate requests or if you need changes made to an - existing certificate, please forward the current certificate - issued with requested changes via E-Mail: - Susan.peragallo@epicbrokers.com- Please Note: All requests for new certificates or changes to existing certificates must be requested by the Named Insured.- cc: The data included in this notice and in the attached document is confidential to Ebix BPO and the party responsible for bringing you this information. 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