# Zurich-American Insurance Group

**231 N. MARTINGALE ROAD**
**SCHAUMBURG, IL 60196**

**TOTAL PREMIUM**
**DEPOSIT PREMIUM**

**INSURANCE COMPANY:**
**ZURICH INSURANCE GROUP**

**PRODUCER NAME:**
**JOE HENRY HOFFMAN**

**PRODUCER NUMBER:**
**084**

**STATE:**
**NY**

**CLASSIFICATION:**
**LARGE MILEAGE**

**CAPACITY:**
**RATE:**

**SECTION:**

**SUPPLEMENT TO AUDIT DATED 6/17/97**

**TOTAL EARNED PREMIUM**
**DEPOSIT PREMIUM**
**ADDITIONAL DUE COMPANY**
**REFUND DUE INSURED**

**JBJ/NS/KLOP 20-97**

**AGENT COPY**

**MM 009804**