Laserfiche WebLink
Bruce Williams \ <br /> � <br /> Sales Representative Signature of Authorized Purc aser <br /> 848/621 217- t � ���� �� <br /> 494-5745 (P) 312-938-4595 (F) C ` �`'l ` <br /> District Phone&FAX Numbers Title <br /> Rick Semonis «�3� �5 <br /> Producer Representative Date <br /> SBSI Semonis, a division of J. L. Hubbard <br /> Insurance and Bonds, Inc. <br /> Producer Firm <br /> 4530 N. University Ave., Peoria, IL 61614 <br /> Producer Address <br /> 309-687-6020 (P) -217-233-3332 (F) <br /> Producer Phone& FAX Numbers <br /> rsemonis@sbsisemonis.com <br /> Producer Email Address <br /> 37-1126488 <br /> Tax I.D. No. <br /> HCSC IL GEN ASO BPA(Rev. 5.15) page 11 <br />