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Temporary Authorization for Release of Information

To the Department of Labor and Industries

Authorization is hereby given to the Department of Labor & Industries to provide our company’s claim history, premium, losses, statistics, experience modification factor and related industrial insurance data to Aspire Consulting LLC (Aspire), along with access to the Department’s online Claim & Account Center. This authorization is effective immediately and granted one year from the date of signature or until withdrawn through our written notification to the Department.

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