WILLIAM IMPERIAL Romac Alum. Const. Corp. P.O. Box 576 Succasunna, NJ 07876 Phone 973-895-3711 or 973-895-5633 N A I Dakota Lawrence 445 Park Ave., 16th Floor New York, NY 10022 Re: COBRA Guardiian - Health Net Subscriber: Dean Imperial ID #: 135746363 Monthly Premium: $ 363.80 Check #: Amount Enclosed: For Month of: