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1001700 2008 137728 208 09-18-2015Page 4 of 4EA 2504.2 Rev. 07-2015 <br />Coverage is not provided until this application is approved by the State Farm Underwriting Department. <br />By submission of this application, you agree that: (1) You have read this application, (2) your statements on this application are correct, (3) the <br />coverages, including options and endorsements, and the amounts of coverage on this application are those chosen by you, (4) the premium charged <br />must comply with State Farm's rules and rates and may be revised, (5) unless certificates of insurance are obtained prior to work, employees of <br />contractors or subcontractors engaged by you will be considered to be your employees, and (6) final premium for the policy will be determined by audit <br />of financial and payroll records. <br />Remarks <br />DocuSign Envelope ID: C91CBC16-495D-4832-812B-E650985A3B1B