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HomeMy WebLinkAboutInsurance Cancellation: American Industrial Door LLC (2) NOTICE OF CANCELLATION,NONRENEWAL,OR DECLINATION OF INSURANCE (Oregon) NAME AND . OHIO SECURITY INSURANCE COMPANY KIND OF I?OLICY: ADDRESS 1001 4th Ave Package Policy OF INSURANCE POLICY/APPLICATION/BINDER NO.: BKS 59761528 COMPANY Seattle WA 98154 EFFECTIVE DATE OF NOTICE: 107/06/2021 12:01 AM I (DATE) (HOUR-STANDARD TIME AT THE ADDRESS OF THE INSURED) DATE OF MAILING: 7/13/2021 NAME AND . AMERICAN INDUSTRIAL DOOR LLC NAME AND ADDRESS OF AGENT/BROKER: ADDRESS 6142 Crater Lake Ave, OF INSURED PAYNEWEST INSURANCE,INC. Central Point, OR 97502 38 N Central Ave Ste 100 Medford OR 97501 (Specific information concerning the cancellation,nonrenewal or declination has been given to the Insured.) TO THE ADDITIONAL INTEREST: You are notified that the above policy is cancelled,nonrenewed or declined 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. AUTHORIZED REPRESENTATIVE NAME AND . City of Ashland ADDRESS OF 20 E Main St ADDITIONAL INTEREST Ashland OR 97520 (E)GU 8940r(Ed.7-20) Wolters Kluwer I Uniform Forms ©2020 Wolters Kluwer Financial Services,Inc.All rights reserved. ADDITIONAL INTEREST'S COPY Page 1 of 1