Colony Insurance Company Artisan Contractors General

COLONY INSURANCE COMPANY ARTISAN CONTRACTORS

91F Page 1 of 1 2005 COLONY INSURANCE COMPANY ARTISAN CONTRACTORS General Agent Name SUPPLEMENTAL APPLICATION Insured: Date _____ Owner/Partner 16,000– (TX – 20,000) $ Risk is a (% of each): Employee Payroll: $ General Contractor _____%

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