HomeMy WebLinkAboutInsurance Cancellation : Humphries Family Enterprises Inc CANCELLATION/NONRYENEWAL NOTICE Page 1 of 1
ADDITIONAL INSURED
Account Number: 339-397-2
Date: 08/09/2021
Place of Issue:
FEDERATED
INSURANCE1®
Insured: 121 East Park Square
HUMPHRIES FAMILY ENTERPRISES INC PO Box 328
5550 HILLCREST RD Owatonna, MN 55060
MEDFORD, OR 97504-9035
Cancellation/Nonrenewal of each policy listed below was requested by the insured.
According to contract language in the policies listed below, we will continue to protect your interest as a
mortgagee, additional insured, or a loss payee through the date and time of day shown below.
Policy Time of
Policy Cancellation/Nonrenewal Policy
Number Policy Type Date Cancellation/Nonrenewal'
9334540 Worker's Compensation 08/02/2021 12:01 a.m.
* Standard time at the designated business premises.
•
CITY OF ASHLAND Loss Payee/
20 E MAIN ST Mortgagee/
ASHLAND, OR 97520-1814 Additional Insured/
Certificate Holder
FEDERATED MUTUAL INSURANCE COMPANY • FEDERATED SERVICE INSURANCE COMPANY* •FEDERATED RESERVE INSURANCE COMPANY*
MFO-40 (08-17) federatedinsurance.com I Not licensed in all states. I 1-888-333-4949