Robert L Moore
robb@truthpointmedia.com
Self
Pleasant Hill
Polk
Iowa
Self, Sole Proprietor and LLC Member, TruthPoint Media LLC
Self, Sole Proprietor and LLC Member, TruthPoint Media LLC
Signed
By selecting the button labeled "Signed", I hereby sign this form and swear or affirm that:
- The information I have provided is true and correct to the best of my knowledge.
- I am authorized to reject or decline to reject employers’ liability coverage on behalf of the corporation.
- I am signing this form in front of the two witnesses I have identified.
- Both of the witnesses are disinterested individuals who are not, formally or informally, affiliated with the corporation.
- I understand that this form is a public record open to public inspection under Iowa Code chapter 22 and section 87.22.