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General Liability Insurance Policy <br />Certificate Request <br />To (Insurance Agency): <br />From (Client Company): <br />"0 <br />MATRI <br />IneSource <br />A Vensure Employer Services Companv <br />Please fax a Certificate of Insurance confirming my General Liability insurance <br />Policy (and auto, if applicable) naming the certificate holder as: <br />JACKSONVILLE, FLORIDA 32256 <br />Fax Certificate to: (904) 739-2725 <br />MOSFORM-FULLPEOENROLLMENTPACK 21 02020 Mat ixOneSource <br />