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450 RAYNOR ANDNU, RONKONKOMA, NY 11779 PMSSU (116) 222-ohs
Fax* f631) 4712905
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DATE
The customs!*am.d abovo hereby states that Alm Wall Corporation has
completed the reatbarntion procedures and repairs to my complete satisfaction.
As pviceirwsly aged, I hereby svhorizc [,n alGM4Wl 2*tL
lesurance Company to pay Alexander Wall Corporation directly the monies approved for that
part of the Jahn aomp eted by them,
In the event that the insurance company makas payment of any instaranco
pommy
ptooeods due to Ale*undnr Wall Corporation directly to me., I agree to Immediately notify
Alexander Wall Corporation, to bold said payment for the benefit of Alexander Wall
Corporation and to promptly pay saran to Atanenier Wall rnrpnmtfnn upon demand.
This authorization does riot release the insurance company from any other aspects
of my dsftn
SIGNATURE
CLAIM NUMBER
POLICY NUMBER
NYC-WTC 000131074
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000131074Source: NYC Law Department, mirrored locally