UTAH INSURANCE DEPARTMENT

EXHIBIT C

CERTIFICATE OF COMPLETION OF CONTINUING EDUCATION

PROVIDER NAME: Mountain CE, LLC

PROVIDER ADDRESS: 3191 S. Valley St., #150, Salt Lake City, UT 84109

PROVIDER PHONE #: (801) 518-1956

 

PRODUCER NAME:  

PRODUCER UTAH LICENSE NUMBER: XXXXXX

 

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

 

 

 

Owner, Mountain CE LLC

 

 

 

RETAIN FOR YOUR FILES IN CASE OF AUDIT