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PROGRAM ADMINISTRATOR KEELSON PARTNERS 707 SW Washington Suite 625 Phone 503. 226. 1422 Ext. 108 Phone 800. 469. 7844 Ext. 108 Fax 503. 226. 2488 Email christmas keelson.com PURCHASING GROUP MEMBERSHIP By applying for this insurance the applicant also is applying for membership in the pursuant to the Liability Risk Retention Act of 1986 15 USC 3901 et seq.

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