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CALIFORNIA DENTAL SERVICE <br /> <br /> (A Not-for-profit Corporation Incorporated in California and a Member of the Delta Dental Plans Association) <br /> <br /> Home Office: P.O. Box 7736, San Francisco, California 94120 <br /> (Herein Called "CDS") <br /> <br /> Group I¢ 2].05 <br /> <br />IN CONSIDERATION of the application made by CTTM OF P, CD~7OOD CTT¥ <br /> ., herein called APPLICANT, a copy of which is attached hereto and made a part of this Contract, <br />and IN CONSIDERATION of payment bY.lthe APPLICANT of the dues as herein provided, CDS herebYMa~,chagrees.ltOw provide the <br />benefits described herein for a period of year(s) beginning at 12:01 a.m., Standard Time, on. <br /> , 19 7 8 , (herein called the Effective Date) and from year to year thereafter, unless this Contract is <br />terminated as provided herein. Dues are payable by Applicant in advance of the Effective Date and thereafter as provided herein. <br />This Contract is issued and delivered in the State of California, is governed by the laws thereof and is subject to the terms and <br />conditions recited on the subsequent pages hereof, which are a part of this Contract as fully as if recited over the signatures hereto <br />affixed. <br /> <br />IN WITNESS HEREOF, COS has caused this Contract to be signed this __ day of <br /> <br />19 <br /> <br /> CALIFORNIA DENTAL SERVICE <br /> <br /> and <br /> <br /> ~SS' [[. ]lICE <br /> <br /> APPLICANT: <br /> <br /> CTT¥ OF ~D~OOD <br /> ~. O. ~oz 39[ <br /> ~e~o~ C~ty~ ~ 94064 <br /> <br /> DESIGNATED AGENT <br /> <br /> <br />