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HomeMy WebLinkAboutInsurance Nonrenewal: Rogue Payroll & Bookkeeping LLC NOTICE OF CANCELLATION, NONRENEWAL,OR DECLINATION OF INSURANCE (Oregon) NAME AND . OHIO SECURITY INSURANCE COMPANY KIND OF POLICY: ADDRESS 175 Berkeley St Package Policy OF INSURANCE POLICY/APPLICATION/BINDER NO.: BZ 26 59958577 COMPANY Boston MA 02116 EFFECTIVE DATE OF NOTICE: 6/15/2025 12:01 AM (DATE) (HOUR-STANDARD TIME AT THE ADDRESS OF THE INSURED) NAME AND . ROGUE PAYROLL&BOOKKEEPING LLC DATE OF MAILING: 6/18/2025 ADDRESS 295 E Main St Ste 2 NAME AND ADDRESS OF AGENT/BROKER: OFINSURED PROTECTORS INSURANCE,LLC Ashland OR 97520 PO Box 4669 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 Oregon And Its Elected Officials, ADDRESS OF officers and employees ADDITIONAL 20 E Main St INTEREST ASHLAND OR 97520 (E)GU 8940s (Ed.1-22) Wolters Kluwer I Uniform Forms ©2022 Wolters Kluwer Financial Services,Inc.All rights reserved. ADDITIONAL INTEREST'S COPY Page 1 of 1