HomeMy WebLinkAboutInsurance Cancellation: Ashland Chamber of Commerce CANCELLATION ENDORSEMENT
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Policy/Certificate Number Policy Cancellation Date Company
CPS7351033 7/4/2021 at 12:01 a.m. Scottsdale Insurance Co.
Named Insured Date of Issue:Jul 12,2021
Ashland Chamber of Commerce Effective Date of Policy:7/4/2021
PO Box 1360 Contract:
Ashland, OR 97520 Issued By:Mary
Submission#:21020663
CHANGES
In consideration of the return premium of($1,001.00),it is understood and agreed that this policy is cancelled in its entirety effective
7/4/2021 due to Insured's Request.
Return Factor 1
Return Premium ($1,001.00)
Fees ($149.00)
State Tax ($23.00)
SLSC ($10.00)
Fire Marshal Tax ($3.45)
TOTAL ($1,186.45)
ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED.
"THIS IS EVIDENCE OF INSURANCE PROCURED AND DEVELOPED UNDER THE OREGON SURPLUS
LINE LAWS. IT IS NOT COVERED BY THE PROVISIONS OF ORS 734.510 TO 734.710 RELATING TO
THE OREGON INSURANCE GUARANTY ASSOCIATION. IF THE INSURER ISSUING THIS INSURANCE
BECOMES INSOLVENT,THE OREGON INSURANCE GUARANTY ASSOCIATION HAS NO OBLIGATION
TO PAY CLAIMS UNDER THIS EVIDENCE OF INSURANCE."
cc: Reinholdt& O'Harra Insurance,Inc
1756 Ashland St
de/
Ashland, OR 97520
City of Ashland Authorized Representative Signature
20 E Main St Griffm Underwriting Services
Ashland, OR 97520
Southern Oregon University
1250 Siskiyou blvd.
Ashland, OR 97520 •
Oregon Dept. of Transportation
100 Antelope Rd
White city, OR 97503