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HomeMy WebLinkAboutInsurance Certificate: City of Ashland NOTICE OF CANCELLATION OR NONRENEWAL NAME AND ADDRESS OF INSURANCE COMPANY KIND OF POLICY: Atlantic Specialty Insurance Company @vantage for Commercial Accounts Plus 1051 Texas Street Salem, VA 24153 POLICY NO.: 710-01-87-69-0012 EFFECTIVE DATE OF NOTICE: 11/22/2019 NAME AND ADDRESS OF MORTGAGEE, LIENHOLDER, 12:01 A.M. STANDARD TIME AT THE ADDRESS OF THE ADDITIONAL INTEREST OR CERTIFICATE HOLDER INSURED CITY OF ASHLAND 20 E MAIN ST DATE OF MAILING: 10/03/2019 ASHLAND, OR 97520-1814 NAME AND ADDRESS OF AGENT/BROKER: CRC INSURANCE SERVICES, INC. - THE ABC PROGRAM DIVISION 906 SOUTH KIRKWOOD ROAD ST. LOUIS, MO 63122 (314)471-0773 (Specific information concerning the cancellation or nonrenewal has been given to the Insured.) ❑ TO MORTGAGEE: Effective 11 / 2 2 / 2 019 at 12:01 A.M. (Standard Time), we hereby cancel or nonrenew the Mortgagee Agreement which is made part of the above mentioned policy and also the above mentioned policy issued to the insured named above covering on at and made payable to you as mortgagee (or trustee), in the event of loss. ❑ TO LIENHOLDER: The above policy is cancelled or nonrenewed effective on and after the hour and date mentioned above. This notice is being provided to you in agreement with the Loss Payable Clause on the above policy. Any interest you may have in the above policy is terminated effective on and after the hour and date mentioned above. ❑X TO THE ADDITIONAL INTEREST: You are notified that the above policy is cancelled or nonrenewed effective on and after the hour and date mentioned above. This notice is being provided to you as you have been provided with a certificate of insurance on the above policy. Any interest you may have in the above policy is terminated. ❑ TO CERTIFICATE HOLDER: You are notified that the above policy is cancelled or nonrenewed effective on and after the hour and date mentioned above. This notice is being provided to you as you have been provided with a certificate of insurance on the above policy. Any interest you may have in the above policy is terminated. NAME AND ADDRESS OF INSURED SKY, LLC PO BOX 1014 MEDFORD, OR 97501-0072 AUTHORIZED REPRESENTATIVE 3 0-23-0003 10/03/2019 AUT CPW CNR 99 01 01 04 Contains Copyrighted Material Of Uniform Information Services, Inc. Page 1 of 1 INSURED.ADDITIONS