HomeMy WebLinkAboutInsurance Certificate: Briscoe Artwing - Reinstatement
REINSTATEMENT NOTICE
KEIZER
OR
97303
KINO OF POLICY:
Commercial General Liability
POLlCYIAPPLlCATIONIBINOER NO.: CLS1330620 Typist: dje
OA TE OF MAILING: 712912009
NAME AND ADDRESS OF AGENTfBROKER:
Reinholdt & Q'Harra Insurance
518WashingtOll 5t
Ashland OR 97520
NAME AND.
ADDRESS
OF INSURANCE
COMPANY
SCOTTSDALE INSURANCE COMPANY
4305 RIVER ROAD N.
NAME AND.
ADDRESS
OF INSURED
Briscoe Artwing
265 Noth Main 51 SE2
ASHLAND
OR
97520
The coverage provided by the policy number shown above and previously cancelled, nonrenewed or scheduled for teomina!ion is being
reinstated effective 7/2812009 at 12:01 AM standard time at the insured's mailing address.
(DATE) (HOUR)
\-L...._L 8...:..
AUTHORIZED REPRESENTATIVE
NAME AND .
ADDRESS OF
ADDITIONAL
INTEREST
City of Ashland, Irs Agents, Directors, Officers & Employees
20 E. Main Street
Ashalnd
OR
97520
(E)GU 560. (Ed. 8-03) UNIFORM
CERTIFICATE HOLDE~S COPY
Pagelof1
NAME AND .
ADDRESS
OF INSURANCE
COMPANY
NAME AND.
ADDRESS
OF INSURED
NOTICE 0Il.lCANGE~I!AJiI0(~~NRENEWAL, CONDITIONED RENEWAL OR DEL
~ "',~ ~""> .~._~:;" --~
. . (Oregon)
SCOTTSDALE INSURANCE eOMPANY
4305 RIVER ROAD N.
ATION OF INSURANCE
KEIZER
OR
97303
KJND OF POLICY:
Commercial General Liabilitv
POLlCY/APPLlCATIONIBINDER NO.: CLS1330620 Tvnist: AGC
EFFECTIVE DATE OF NOTICE:
8/19/2009 12:01 AM
(DATE) (HOOR-STANOARO TIME AT THE ADDRESS OF THE INSURED)
DATE OF MAILING: 7/16/2009
NAME AND ADDRESS OF AGENTIBROKER:
Reinholdl & O'Harra Insurance
518 Washington St
Ashland OR 97520
Briscoe Artwing
265 Noth Main St SE2
ASHLAND
OR
97520
(Specific Information concerning the cancellation
or nonrenewal has been given to the Insured.)
TO CERTIFICATE HOLDER:
You are notified thai the above policy is cancelled or nonrenewed 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.
NAME AND.
ADDRESS OF
CERTIFICATE
HOLDER
\cl--",~ If'.~
AU1l10RlZfO REPRESENTATIVE
City of Ashland, It's Agents, Directors, Officers & Employees
20 E. Main Street
Ashalnd
OR
97520
(EIGU 8940) (Ed. 6'{)4) UNIFORM
CERTIFICATE HOLDER'S COPY
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