HomeMy WebLinkAboutInsurance Certificate: Ashland Chamber of Commerce (2)
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NOTICE TO LIENHOLDER/MORTGAGEE/
ADDITIONAL INSURED/CERTIFICATE HOLDER
FOREMOST SIGNATURE INSURANCE COMPANY
(Refer to envelope for insurance company address)
CITY OF ASHLAND, ITS OFFICERS,
EMPLOYEES AND AGENTS
20 EAST MAIN STREET
ASHLAND OR 97520-
POLICY NO. INSURED ASHLAND CHAMBER OF COMMERCE
PPS 39636353
GENT
REINHOLDT & O'HARRA INSURANCE
INSURING COMPANY
FOREMOST SIGNATURE INSURANCE COMPANY
REFERENCE
TO LIENHOLDER:
You are hereby notified that the agreement under the Loss Payable Clause payable to you as
Lienholder which is part of the above policy, issued to the above insured, has been or will be
cancelled or nonrenewed in accordance with the conditions of the policy. Your interest under this
policy ceases effective
TO MORTGAGEE:
The Mortgagee Agreement in the above mentioned policy has been or will be cancelled or
o nonrenewed. Your interest under this policy ceases effective
TO ADDITIONAL INSURED:
X This is to notify you that the above captioned policy which names you as an Additional Insured has
been or will be cancelled in accordance with the conditions of the policy. Your interest under this
o policy ceases effective 02/03/2015
TO CERTIFICATE HOLDER:
This is to notify you that the above captioned policy for the above named insured has been or will
be cancelled. Your interest in this policy ceases effective
8 NOV 1 7 2014 11/12/2014
$ Date of Mailing
a
990028 (3/94) THIRD PARTY COPY