HomeMy WebLinkAboutInsurance Cancellation: Tara Labs
~ Libe~
~ Northwest.
Member of Uberty Mutual Group
PO Box 5048, Portland, Or 97208-5048
t 503.736.7600 f503.736.7620
NOTICE OF CANCELLATION
of
Certificate of Insurance, Loss Payable Clause or Mortgage Clause
You hold a Certificate of Insurance, Loss Payable Clause or Mortgage Clause under which you are a Payee in connection with the
policy described below. Please accept notice that coverage is hereby cancelled as respects such Certificate, Loss Payable Clause or
Mortgage Clause; and such coverage shall terminate as of the date and hour shown hereon.
Agent ASHlAND INSURANCE, INC.
Code 1090-30 jp
Policy Number CI014-86-72
Termination effective (12:01 A.M.)
12/30/08
Name of Insured TARA LABS INC. TARA Li\BS INC 401K PL'\N
Address 550 CLOVER LANE ASHLAND OR 97520
o Cancellation applies to entire Certificate.
o Cancellation applies only to
RE: LOCATION AT 550 CLOVER LANE ASHlAND, OR 97520
To Certificate Holder, Loss Payee or Mortgagee
Countersigned at PORTLAND, OREGON
this 1911-1
THE CITY OF ASHLAND, ITS OFFICERS,
COMMISIONS. ELECTED OFFICIALS & EMPLOYEES
day of December. 2008
o NORTH PACIFIC INSURANCE COMPANY
20 EAST MAIN ST
o LIBERTY NORTHWEST INSURANCE COMPANY
ASHLAND. OR 97520-1849
o OREGON AUTOMOBILE INSURANCE COMPANY
~~
BY
-..~~..._~_._.. ~--.._--_.. ...-.------ ------ ~ ..-------- ~
--------
-------rTrT
III I -