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DATE (MM/DD/BY)CERTIFICATE OF INSURANCE PRODUCERYour Agent or Brokers CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES
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This certificate does not provide tax exemption status.
All businesses operating in this state are required to file this certificate.
You can fill out this certificate online through the state's official website.
The purpose of this certificate is to declare the business's compliance with state regulations.
The certificate must include the business's legal name, address, and tax ID number.
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