WILLIAM IMPERIAL Romac Alum. Const. Corp. P.O. Box 576 Succasunna, NJ 07876 Phone 973-895-3711 or 973-895-5633 Hopatcong Board Of Education P. O. Box 1029 Hopatcong, New Jersey 07843 Re: COBRA CIGNA Health Care Subscriber: Jolene Imperial ACCOUNT #: 0423509 SS # 152-46-2517 Monthly Premium: $ 993.00 Check #: Amount Enclosed: For Month of: