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HomeMy WebLinkAboutJ. HAROLD SMITH - SMITH ELECTRIC SUPPLY - 6/14/70 NOTICE OF CANCELATION LOSS PAYEE'S COPY. The below numbered policy, issued to the Named Insured by the Company or Companies named herein,is canceled as of the Effective Date of Can- celation stated below. No endorsement or continuation certificate and no act of the Company(ies),the Named Insured or any agent of either shall extend this policy to apply after said Date unless this cancelation is specifically rescinded by the Company(ies) and the policy is thereby specifically reinstated. 72 2 Named Insured and Address Policy No......72...C...Z ................ , HARAKD SMITH i J HAROLD SMITH JR i SMITH ELECTRIC SUPIY CERT MOLTER,. 107" KWT ME Name and Address of hPno-Payee if any STAl1T4N► � r 72 C 208"9 94TY OF HWT 1NGTON BEACH P O BoX 190 HIM 1 NGTON BEACH, CALIF L J _ EFFECTIVE DATE OF CANCELATION:(At the address of the Named Insured as stated in the policy) OCTOBER' 24, 1972 (11M AM STO-TOW) - Companyues) HARTFORD ACCIDENT AND INDEMNITY CONFM Any return premium due under this policy, if not tendered herewith, will be returned upon demand. (KANSAS: The words"upon demand"are deleted.) THE HARTInA FORD INSURANCE GROUP A.� JaHARTFORD. CONNECTICUT Date............10...12... .............. Authorized Signature........ ..<��� T`.:..:'.....1.<;-r P .......:`::.. ............................................... x Producer's Name and Address r H NT ERIC MOORE AND ASSOC INC 180172 L A Form G-2299-3 Printed in U.S.A. 3-'68 CERTIFICATE OF INSURANCE B m Hartf—Fire Insurance Company a®Ne, _irk Underwriters Insurance Company THE MRTFORD "®Hartf-,.-Accident and Indemnity Company "®Tw. ;ity Fire Insurance Company INSURANCE GROUP v®HARTFORD,CONNECTICUT Citizens Insurance Company of New Jersey CffCode'Phis is to certify that the company designated herein by Co. Code has issued to the named insured Named Insured and Address the policies enumerated below. Smith Electric Supply 10792 Knott Avenue Stanton, California The policies indicated herein apply with respect to the hazards and for the coverages and limits of liability indicated by specific entry herein but this certificate of Insurance does not amend, extend or otherwise alter the terms and conditions of the insurance coverage in the policies identified herein. Coverages and Limits of Liability (SINGLE LIMIT) (DUAL LIMITS) Policy Number Bodily Injury and Bodily Injury Liability Property Damage Liability Hazards and Property Damage Liability Policy Term *each aggregate *each *each aggregate occurrence gg gate each person occurrence occurrence General Liability 1/1/7 2—1/1/7 3 Premises-Operations 7 2 C 20 8 299 $ 000$ 000$ 5 0 0 000$1,0 0 0,000$ 10 0 000$ 2 5 0,000 Independent Contractors f $ 000$ 000$ 5 0 0 000$1,0 0 0,000$ 10 0 000$ 2 5 0,000 Completed Operations; $ 000$ 000$ 5 0 0 000$1=0 0 0,000$ 10 0 000$ 2 5 0,000 Products $ 000$ 000 Aggregate: $1,0 0 0,000 XXXX XXXX Contractual(as described below) , $ 000$ 000$ 5 0 0 000$1,0 0 0,00 $ 10 0 000$ 2 5 0,000 Automobile Liability Owned Automobiles s i $ ,000 XXXX $ 5 0 0 1000$1�0 0 0 1000$ 100 000 XXXX Hired Automobiles $ ,000 xxxx $ 500 000%0 0 0,0 $ 100 000 xxxx Non-Owned Automobiles $ ,000 xxxx $ 500 000$l,0 0 0,000 $ 100 000 xxxx Workmen's Compensation Compensation—Statutory and Employers'Liability Employers' Liability — $ ,000 Umbrella Liability $ 000,000 *If with respect to Automobile Liability the Policy Number entered above includes the symbol GB,AZ,MVP,MAG or PGB,the word"occurrence" is amended to read"accident". _ Location and description of operations, automobiles, contracts, etc. (For contracts, indicate type of agreement, party and date.) If policy is canceled, 10 days City of Huntington Beach written notice will be given to: p. 0. Box 190 Huntington Beach, Calif. E 1C PA00:1E :^`-C! ,TES ERIC MOORE & ASSOCIATES/mg 12/22/71 Date 541 E. i l:,�i i`w;i^I AVE. By..........�W' ...¢.............. ...... ��................................ Authorized Representative ORANGE, GNI_(;=013;'�i�, 92567 Forth AL-12-2 Printed in U.S.A. 9-70 Named Insured and Address This endorsement forms a part of Policy No._... ...Z N. C Z088 issued by TILE IIA KTFOI fD INSURANCE G OUP compa�ny�desig- noted therein, and takes effect as of the effective date of said policy unless another effective date is stated herein. Effective date..... ...... . ..........................:.........................12:01 A. M.,standard time at the address of the nanted insured as stated herein. ADDITIONAL INSURED (CONTRACTOR'S PROTECTIVE) This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following: COMPREHENSIVE GENERAL LIABILITY INSURANCE MANUFACTURERS ' AND CONMCTORS ' LIABILITY INSURANCE IT IS AGREED THAT: 1. PERSONS INSURED : THE UNQUALIFIED -WORD-INSURED WMEVER USED IN THE POLICY ALSO INCLUDES THE PERSON OR ORGANIZATION 19M BELOW (HEREINAFTER CALLED "ADDITIONAL INSURED' BUT ONLY, WITH RESPECT TO,j 1) ,OPERAI TIONS HEREINAFTER DESCRIBED PERFORMED FOR THE� ADD I' IOXXL'Ii UAED BY THE""kAMED 'INSURER: OR (2) ACTS OR OMISSIONS OP THE ADDITIONAL UR' COWnCTIU T'ITH-ITM 7ffENERAL SUPERVISION OF SUCH OPERATIONS.- 2. EXCLUSIONS : , . WITH 'RESPECT TO THE ADDITIONAL 7 to ID, .1mS INSURANCE DOES NOT APPLY: (A) TO BODIL' tIN3 URY .T0 "AN` W'LOYEE OF'THE ADDITIONAL INSURED OR OF THE NAMED INSURED AISII { . 01t ". R IN THEE `O� CH E ? OYMENT. (B) TO LIABILITY AHSYt ,DDITIONAL INS UNDER ANY CONTRACT OR AGREEMENT: (C) TO BODILY•rINJ`URY OR PR(H' 'T7E sAMAGE OOCURRING AFTER. (1)�4Lfq (�ffI (`� 'I` iN-SERVICE, MAINTENANCE OR REPAIR, TO B RFORMl 3 BY' ON- BEHALF OF THE ADDITIONAL INSURED AT THE SITE OF THE COVERED OPERATIONS. HAS BEEN COMPLETED OR (2) THAT PORTION OF THE NAMED INSURED 'S WORK OUT OF WHICH THE INJURY OR DAMAGE ARISES HAS, BEF, PUT 'TZ? TS�N�lr ENDED USE BY ANY PERSON OR ORGANIZATION OTHER THAN :ANOTHER CONTRACTOR OR SUBCONTRACTOR ENGAGE 5-IN PERFORMING OPERATIONS FOR A PRINCIPAL AS A PART OF THE SAME PROD ECT; 3. ADDITIONAL DEFINITION: WHEN USED IN REFERENCE TO THIS INSURANCE-: "WORK" INCLUDES MATERIALS, PARTS AND `EQUIPMENT FURNISHED IN CONNECTION EREWITH. SCHEDULE NAME OF ADDITIONAL INSURED DESCRIBED OPERATIONS C IT'f OF HUMT I NGTON BEACH L3125-0 VAR I OI;. JOPS � "tE 17IT" FALL, HUNTUMON SEADi, CA. t: p�". l 'ERlOEJ RATE PER $100 CONTRACT COST PREMIUM ESTIMATED CONTRACT COST BI PD BI PD Nothing herein contained shall be held to vary, waive, alter, or extend any of the terit s, condition;, agrectiwnt- or o-,t than as herein stated. This end,w ement shall not be bindink Wile— couittersivned by a dub., authorized acrnto{ tl�o c1 .t--w P!, effect a�of th'. 0,'rrtivc d.:te of the polio% aud, at t,.ue ui ,maid poiicv, form- a J>,o t t i"; by a dul_c ais j ll r1/'d a ent 4 the conip.in_\ 'h.tll constitute valid Coll ntcrrign'ttu:t+ SARO 313 a CERTIFICATE OF INSURANCE o®Hartford Fire Insurance Company b®New York Underwriters Insurance Company THE INTFORD ®Hartford Accident and Indemnity Company "[T Twin City Fire Insurance Company INSURANCE GROUT' 41 HARTFORD.CONNECTICUT "®Citizens Insurance Company of New Jersey This is to certify that the company designated Co.Code herein by Co.Code has issued to the named insured 5 _1 Named Insured and Address the policies enumerated below. SMITH ELECTRIC SUPPLY 10792 KNOTT AVENUE STANTON CALIF. The policies indicated herein apply with respect to the hazards and for the coverages and limits of liability indicated by specific entry herein but this certificate of insurance does not amend, extend or otherwise alter the terms and conditions of the insurance coverage in the policies identified herein. Coverages and Limits of Liability (SINGLE LIMIT) (DUAL LIMITS) I Policy Number Bodily Injury and Bodily Injury Liability Property Damage Liability and Property Damage Liability Hazards — Policy Term *each *each *each aggregate occurrence aggregate each person occurrence occurrence General Liability 01 7.L172 1 Premises-Operations _ 72C208089 _ $ 000$_ 000$ 500,000$ 1000,000s 100,000$ 250,000 Independent Contractors $ ,000$_ 000$ 500,000$ 1000,000$ 100,000$_ 250,000 Completed Operations; $ ,000$ ,000$ — �,000$-7-0�-000$ 100,000$_ Z5C,000 Products _ $ ,000$ ,000 Aggregate: $ L00D,000 XXXX XXXX Contractual(as described below) " $ 000$ 000$ 500,000$ 1000,000$ 100,000$ 250,000 Automobile Liability �t Owned Automobiles $ ,000 XXXx $ 500,000$ 1000,000$ 100,000 xxxx Hired Automobiles $ ,000�i xxxx _$ 500,000$ 1000,000$ 100,000 XXXX_ Non-Owned Automobiles " $ 000� xxxx $ 500,000$ 1000,000$ 100,000 XXXX Workmen's Compensation Compensation—Statutory and Employers' Liability Employers' Liability — $ ,000 i Umbrella Liability $ 000,000 *If with respect to Automobile Liability the Policy Number entered above includes the symbol GB,AZ,MVP,MAG or PG13,the word"occurrence" is amended to read"accident". Location and description of operations, automobiles, contracts, etc. (For contracts, indicate type of agreement, party and date.) ROAD IMPROVEMENTS , TRAFFIC SIGNALS AND HIGHWAY LIGHTING ON BONITA CANYON DRIVE AT THE INTERSECTION OF MACARTHUR BLVD. COUNTY OF ORANGE, CALIF. If policy is canceled, 10 DAYS CITY OF HUNTINGTON BEACH written notice will be given to: P. 0. BOX 190 HUNTINGTON BEACH CAL. FEBRUARY 26, 1971 ERIC MOORE & OCIATES Date By................ ......... _ .c ,f„/.................... ntative Form AL-12-2 Printed in U.S.A. 9-'70 f " NCELLATION NOTICT To.. .........46��......... You are hereby advised that the below indicated policy has been terminated as of the below mentioned date. Name ©f Assured ........ ...... ................ ........ ..................................... Address of Assured.10.711�... ......................................................... 'B"FAR"s. .5 Policy No. i;-.0 Effective date of Cancellation........ ................... ........19..z/. Cancelled by Company The above described policy has been Cancelled by Assured returned, not taken. Insurance Carrier: By ..................... e; .................................... Datedat This .........................day of.......FE 10.........................I...... FORM COMP 3582-A CERTIFICATE OF INSURANCE GENERAL BUILDINGS, PHILADELPHIA, PA. 19105 ® CFIRE &ORPORATFONALSMRGENERAL ACCIDENT ANCEITED INSURANCE ASSOCIATION aINSURANCE COMPANY ❑INSURANCE COMPANY AL This is to certify to: w CITY OF HUNTINGTON BEACH _ F. 0 BOX 190 Address TRINTTNC1TON BRAAC_.H, CALIFORNIA — that the company indicated above by the letter X has issued the following described policies: Name of Insured J- HARO LD SMTTTH AND rT- THAROTM SMITH, JR- _ PIRA • SMITH yracTRIC SUPPLY Address _ l0r7Q2 100 T AV MM STANTON CA.T,IFORNIA POLICY EFFECTIVE EXPIRATION NUMBER KIND OF INSURANCE LIMITS DATE** DATE** * Workmen's Compensation and Employers' Liability * Public Liability Each Person Each Occurrence Aggregate LA 39-227-50 Bodily Injury $ 500,000. $1000,000. $1000,000. 6-14-70 6-14-71 Property Damage x x x x $ 100,000_ $ 250,000. * Automobile Liability LA 39-227-50 Bodily Injury $ 500,000. $1000,000. xxxx 6-14-70 6-14-71 Property Damage x x x x $ 100 000. x x x x _ * Form Amount Burglary $ * Plate Glass *Absence of an entry in these spaces means that insurance is not afforded with respect to the coverages opposite thereto. ** Policy is effective and expires at 12:01 A.M., standard time at the address of the named insured as stated herein. Description of Operations Covered: ALL OPERATIONS IN THE EVENT OF CANCELLATION, OR REDUCTION IN COVERAGE OF ANY OF THE POLICIES SPECIFIED HEREIN, THE INSURER AGREES TO GIVE TEN (10) DAYS PRIOR WRITTEN NOTICE TO THE PARTY AT WHOSE REQUEST THIS CERTIFICATE IS ISSUED. This Certificate of Insurance neither affirmatively nor negatively amends,extends or alters the coverage afforded by the policy orpolicies described herein,ondis issued subject to the exclusions, conditions and other terms of the insurance afforded under the policy or policies hereinbefore mentioned. I s su ed at LOSS ANGELES CALIF. Date—..�=�-_7Q SO CALIF BR AiPA lot A 03 0% Auth i zed Agent FORM G-4142 REV. 3/69 ; 1 ENDORSEMENT NOT VALID UNLESS SIGNE. Y A DULY AUTHORIZED REPRESENTATI OF THE COMPANY Date and Place of Issue Effective From (Standard Time as stated in Policy) Amending Policy No. Issued To by GENERAL ACCIDENT FIRE AND LIFE ASSURANCE CORPORATION, LIMITED, or THE CAMDEN FIRE INSURANCE ASSOCIATION, or POTOMAC INSURANCE COMPANY, or PENNSYLVANIA GENERAL INSURANCE COMPANY as the interest of any such company shall appear in the policy. (The information provided for above is required to be stated only when this endorsement is issued for attachment to the policy subsequent to its effective date.) IN CONSIDERATION OF AN ADDITIONAL PREMIUM OF $13.00 INCLUDED, IT IS UNDERSTOOD AND AGREED THAT WITH RESPECT TO SUCH INSURANCE AS IS AFFORD- ED BY THE POLICY UNDER COVERAGE C, BODILY INJURY LIABILITY-AUTOMOBILE, COVERAGE A, BODILY INJURY LIABILITY-EXCEPT AUTOMOBILE, COVERAGE D, PROPERTY DAMAGE LIABILITY-AUTOMOBILE, AND COVERAGE B, PROPERTY DAMAGE LIABILITY-EXCEPT AUTOMOBILE: . 1. THE UNQUALIFIED WORD "INSURED" WHEREVER USED IN THE POLICY ALSO INCLUDES THE CITY OF HUNTINGTON BEACH, CALIFORNIA, BUT ONLY AS RESPECTS OPERATIONS PERFORMED BY OUR INSURED FOR THE CITY OF HUNTINGTON BEACH, CALIFORNIA. 2. THE INCLUSION OF THIS ADDITIONAL INSURED SHALL NOT OPERATE TO INCREASE THE LIMITS OF THE COMPANY'S LIABILITY. 9 i i Additional Premium Return Premium State Code No. Agent's Code No. i This endorsement is subject to all the agreements, conditions and exclusions of the policy unless such agree. ments, conditions and exclusions are expressly modified or expressly eliminated hereby. .1 AA A �_KAIOCJ/h FORM G-1881-s REV. 9-64 Authorized Re esentative (� CERTIFICATE OF INSURANCE GENERAL BUILDINGS, PHILADELPHIA, PA. 19105 CORPORATION,FIRE & LIFE I MRANCETED INSURANCE ASSOCTHE CAMDEN FIRE IATION �PNSUORANCE COMPANY ❑INSURANCE COMPANY GENERAL ACCIDENT RAL This is to certify to: CITY OF HUNTINGTON BEkCH P- Q. BOX 0 -- Address HUidTIECIT011 BEEkCN, CAIIFOPHIA that the company indicated above by the letter X has issued the following described policies: Name of Insured J. iAROLD SHITH 1111D J HAROLD SMITH, JR. FCTr T�(,' StTy PT,Y Address 1o792 '7,110TT AVM+ UFF S'TtAIT'? )N '�TIT-2f 'RN, TA POLICY KIND OF INSURANCE LIMITS EFFECTIVE EXPIRATION NUMBER DATE DATE STATUTORY Workmen•s Compensation Public Liability Each Person Each Occurrence Aggregate GLA 38-566-02 Bodily Injury $ 500,000. $1000,000. $1000,000. 6-14-69 6-14-70 Property Damage x x x x $ 100,00o. $ 2501-000. Automobile Liability GLA 38-566-02 Bodily Injury $ 500,000. $1000,000. x x x x 6-14-69 6-14-70 Property Damage x x x x $ 100 000. x x x x Form Amount Burglary $ Plate Glass Description of Operations Covered: ALL OPMkTIONS IN THE EVENT OF CANCELLATION, OR REDUCTION IN COVERAGE OF ANY OF THE POLICIES SPECIFIED H=- EIN, THE INSURER AGREES TO GIVE TEN (10) DAYS PRIOR WRITTMT NOTICE TO THE PARTY AT WriOS E REQUEST THIS CERTIFICATE IS IS STj'ED. i This Certificate of Insurance is issued subject to the exclusions, conditions and other terms of the insurance afforded under the policy or policies hereinbefore mentioned" i Issued at LOS rt TGELES, GATIIP, . Date 4-23—G9 SQ__. U l-_.-13— Authorized Agent 14/49 ENDORSEMENT NOT VALID UNLESS SIGNED A DULY AUTHORIZED REPRESENTA'i..JE OF THE COMPANY i Date and Place of Issue Effective From (Standard Time as stated In Policy) Amending Policy No. Issued To by GENERAL ACCIDENT FIRE AND LIFE ASSURANCE CORPORATION, LIMITED, or POTOMAC INSURANCE COMPANY, or THE CAMDEN FIRE INSURANCE ASSOCIATION, or PENNSYLVANIA GENERAL INSURANCE COMPANY as the interest of any such company shall appear in the policy. (The information provided for above is required to be stated only when this endorsement is issued for attachment to the policy subsequent to Its effective date.) IN CONSIDERATION OF All ADDITIONAL PREMIUM OF $7.00 INCLUDED, IT IS AGREED THAT WITH RESPECT TO SUCH INSURANCE AS IS AFFORDED BY THE POLICY UNDER COVERAGES C, BODILY INJURY LIABILITY-AUTOMOBILE, COVERAGE A, BODILY INJURY LIABILITY-EXCEPT AUTOMOBILE, COVERAGE D, PROPERTY DAMAGE LIABILITY-AUTOMOBILE, AND COVERAGE B, PROPERTY DAMAGE LIABILITY-EXCEPT AUTOMOBILE. 1. THE UNQUALIFIED WORD "INSURED" WHEREVER USED IN THE POLICY ALSO INCLUDES THE CITY OF HUNTINGTON BEACH, CALIFORNIA, BUT ONLY AS RESPECTS OPERATIONS PERFORMED BY OUR INSURED FOR THE CITY OF HUNTINGTON BEACH, CALIFORNIA. 2. THE INCLUSION OF THIS ADDITIONAL INSURED SHALL NOT OPERATE TO INCREASE THE LIMITS OF THE COMPANY'S LIABILITY. Additional Premium Return Premium State Code No. Agent's Code No. This endorsement is subject to all the agreements, conditions and exclusions of the policy unless such agreements, conditions and exclusions are expressly modified or expressly eliminated hereby. FORM G-1881-S REV. 9-64 Authorized Representative CERTIFICATE OF INSURANCE GENERAL BUILDINGS, PHILADELPHIA, PA. 19105 ®CORPORATION SLIMIITEDE F NSURA CE ASSOCIATION a GENERAL ACCIDENT THE CAMDEN FIRE PNSURANCE COMPANY ❑pNSURANCE COMPANY AL This is to certify to: CITY OF HUNTINGTON BEACH P.O. Box 190 Address HUNTINGTON BEACH, CALIFORNIA— that the company indicated above by the letter X has issued the following described policies: Name of Insured J. HAROLD SMITH, DBA: SMITH ELECTRIC SUPPLY 10792 KNOTT AVENUE Address STANTON, CALIFORNIA POLICY K1 URANCE LIMITS EFFECTIVE EXPIRATION NUMBER DATE DATE Workmen•s Compensa . n STATU RY Public Liability Each Person Ea Occurrence Aggregate GLA37-654-78 Bodily Injury $300 ,000. 00 ,000. $500 Property Damage x x x x $ 50 ,000. $ 50 ,000. 6/14/68 6/14/69 Automobile Liability GLA37-654-78 Bodily Injury $ 3 0 ,boo. $500 ,000. x x x x 6/14/68 6/14/69 Property Damage x x x $100 000. x x x x Arm Amount Burglary $ Plate Glass _F Description of Operations Bred: ALL OPERATIONS IN THE EVENT OF CANCELLATION, OR REDU ION IN COVERAGE OF ANY OF THE POLICIES SPECIFIED HEREIN, THE INS R AGREES TO GIVE TEN (10) DAYS PRIOR WRITTEN NOTICE TO THE PARTY T WHOSE REQUEST THIS CERTI— FICATE IS ISSUED. This Certificate of Insurance is issued subject to the exclusions, conditions and other terms of the insurance afforded under the policy or politic reinbefore mentioned. Issued at Orange, California ����� Date 54;4,/68 Authori zed Agent FORM G-4142 10-66 #52 - ENDORSEMENT NOT VALID UNLESS SIGNED .,f A DULY AUTHORIZED REPRESENT. VE OF THE COMPANY Date and Place of Issue Effective From (Standard Time as stated in policy) Amending Policy No. Issued To by GENERAL ACCIDENT FIRE AND LIFE ASSURANCE CORPORATION, LIMITED, or POTOMAC INSURANCE COMPANY, or THE CAMDEN FIRE INSURANCE ASSOCIATION, or PENNSYLVANIA GENERAL INSURANCE COMPANY as the interest of any such company shall appear in the policy. !M infom+etion Wovided for above is required to be stated only when this endorsement •issued for attachment to the policy subsequent to its effective date.) IN CONSIDERATION OF AN ADDITIONAL PREMIUM OF $7.00 INCLUDED, IT IS AGREED THAT WITH RESPECT TO SUCH INSURANCE AS I$ AFFORDED BY THE POLICY UNDER COVERAGES C. BODILY INJURY LIABILITY — AUTOMOBILE, COV— ERAGE Ae BODILY INJURY LIABILITY — EXCEPT AUTOMOBILE, COVERAGE D. — PROPERTY DAMAGE LIABILITY — AUTOMOBILE, COVERAGE Be PROPERTY DAMAGE LIABILITY — EXCEPT AUTOMOBILE: 1. THE UNQUALIFIED WORD "INSURED" WHEREVER USED IN THE POLICY ALSO INCLUDES THE CITY OF HUNTINGTON BEACH, CALIFORNIA, BUT ONLY AS RESPECTS OPERATIONS PERFORMED BY OUR INSURED FOR THE CITY OF HUNTINGTON BEACH, CALIFORNIA, Z. THE INCLUSION OF THIS ADDITIONAL INSURED SHALL NOT OPERATE TO INCREASE THE LIMITS OF THE COMPANYIS LIABILITY. Additional Premium Return Premium State Code No. Agent's Code No. $ $ This endorsement is subject to all the agreements, conditions and exclusions of the policy unless such agreements, conditions and exclusions are expressly modified or expressly eliminated her y. ---------- ------------------------—------------- F ORM G-1881-S REV. 9-64 Authorized Representative