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Er of Insured Vendor name and address 1c. NYS Unemployment Insurance Employer Registration Number of Insured 1d. Federal Employer Identification Number of Insured or Social Security Number 2. Name and Address of the Entity Requesting Proof of Coverage (Entity Being Listed as the Certificate Holder) 3a. Name of Insurance Carrier New York State Office of General Services Design and Construction Group Division of Contract Administration 35th Floor - Corning Tower, GNARESP Albany, NY 12242 3b.

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