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| Company Name: | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY |
| Employer identification number (EIN): | 602331200 |
| National Association of Insurance Commissioner's ID: | 68195 |
| NAIC Classification: | 68195 |
| CLAY CHEVROLET, INC. | CLAY CHEVROLET, INC. GROUP INSURANCE PLAN | 2015-04-01 |
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