Test Certificiate

UTAH INSURANCE DEPARTMENT

EXHIBIT C

CERTIFICATE OF COMPLETION OF CONTINUING EDUCATION

PROVIDER NAME: Mountain CE LLC

PROVIDER ADDRESS: 9690 South 300 West, Suite 331, Sandy, UT 84070

PROVIDER PHONE #: (801) 518-1956

AUTHORIZED REPRESENTATIVE: Marlene K. Mauer

PRODUCER NAME:

PRODUCER UTAH LICENSE NUMBER:

UTAH DOI COURSE TITLE:

COURSE NUMBER:

COURSE TYPE: Classroom Equivalent

COURSE HOURS:

COMPLETION DATE:

The above have been certified by the Utah Insurance Department pursuant to Department Rule No. R590-142

DATE:                                           owner, Mountain CE LLC

RETAIN FOR YOUR FILES IN CASE OF AUDIT