GROTON AMBULANCE ASSOCIATION, INC.

Contact Information

POC	CHESTER J. KANIECKI
Phone	+1 860-867-6800
Address	217 NEWTOWN RD, GROTON, CT, 06340 4354, UNITED STATES

Ownership of Offeror Information

Highest Level Owner	Information not Available

Immediate Level Owner	Information not Available

List of Offerors (0)	Information not Available

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2017-11-01
Business code	621900
Sponsor’s telephone number	8604456925
Plan sponsor’s address	217 NEWTOWN ROAD, GROTON, CT, 06340

Signature of

Role	Plan administrator
Date	2019-06-04
Name of individual signing	CHET KANIECKI
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2017-11-01
Business code	621900
Sponsor’s telephone number	8604456925
Plan sponsor’s address	217 NEWTOWN ROAD, GROTON, CT, 06340

Signature of

Role	Plan administrator
Date	2019-02-12
Name of individual signing	CHESTER KANIECKI
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2019-02-12
Name of individual signing	CHESTER KANIECKI
Valid signature	Filed with authorized/valid electronic signature