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SF ~ REG ~ a <br /> Affiliated FM Insurance Company <br /> P. O. Box 7500 Johnston RI 02919 <br /> CLIENT: CITY OF EUGENE ACCOUNT NO: 0032981 <br /> LOCATION OF LOSS: EUGENE OR POLICY NO: OOP6123 <br /> CLAIM NO: SP156 <br /> DATE OF LOSS: 1/1/2009 ~ CLAIM ID: 000180339 <br /> CLAIMS OPS. OFFICE: SAN FRANCISCO INVOICE ID: P0088839 <br /> CHECK NO: 113836 <br /> CHECK DATE: 4/28/2009 <br /> AMOUNT: ***$41,425.00 <br /> ~ 2t'r I s e Y 7 .a.a. ' e ~ e ~ <br /> 5 i-aa <br /> Bank of America 11e <br /> Affiliated FM Insurance Company DATE CHECK NO. ! <br /> <br /> " P: O. Box 7r+OQ Johnston, RI Q291~ <br /> 4/28/2009 113836 <br /> PAY: ~~~"Forfy-one thousand four hundred Twenty-five and xx / 100 Dollar`''" <br /> CHECK AMOUNT <br /> TO THE ORDEF: OF: *~k$41,425.00 <br /> CITY OF EUGENE"" <br /> Affiliated FM Insurance Company <br /> O~ <br /> Authorized Signature ~ <br /> ~ ^r-- ~ <br /> ~ ~ ~ <br /> Authorized Signature <br /> . _ . <br /> i...-.. <br /> 11' l X383611' ~:0 L L900445~: 00000005563411• <br /> <br />