HomeMy WebLinkAboutInsurance Certificate: Terrasurvey, Inc. NOTICE TO LIENHOLDER/MORTGAGEE/
ADDITIONAL INSURED/CERTIFICATE HOLDER
FOREMOST INSURANCE COMPANY GRAND RAPIDS, MI
(Refer to envelope for insurance company address)
CITY OF ASHLAND
20 E MAIN ST
ASHLAND OR 97520--1814
POLICY NO. INSURED
TERRASURVEY, INC
PAS 43357319
AGENT
ASHLAND INSURANCE, INC.
INSURING COMPANY
FOREMOST INSURANCE COMPANY GRAND RAPIDS, MI
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
nonrenewed. Your interest under this policy ceases effective
TO ADDITIONAL INSURED:
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
policy ceases effective
TO CERTIFICATE HOLDER:
X 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 05/10/2019 .
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V
02/28/2019
o Date of Mailing
990028 (3/94) THIRD PARTY COPY
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