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FIRM NUMBER <br />(As assigned by L &I) <br />FIRM NAME PUGET SOUND CITIES INSURANCE AUTHORITY <br />CITY OF TUKWILA <br />Authorization is hereby given to the Department of Labor <br />and Industries to provide statistics, data and information <br />covering the Workers Compensation Account of this firm to The <br />Puget Sound Cities Insurance Authority and /or Lewis E. Leigh, <br />Executive Director of the Puget Sound Cities Insurance Authority. <br />This authorization is effective immediately and will remain in <br />effect until written notice of withdrawal of this authorization <br />is received in the Department of Labor and Industries. <br />Dated this 4th day of April 1985 <br />BY <br />TITLE. Mayor <br />ATTEST /77a, ��/57 <br />TITLE City Cl erk <br />Gary L Van Dusen <br />Above Signature Typed <br />