HomeMy WebLinkAboutInsurance Certificate: Briscoe Artwing
NOTICE OF CANCELLATION, NONRENEWAL, CONOITIONED RENEWAL OR. DECLINATION OF INSURANCE
(Oregon)
NAME AND.
AODRESS
OF INSURANCE
COMPANY
SCOTTSDALE INSURANCE COMPANY
4305 RIVER ROAD N.
KEIZER
DR
97303
KIND OF POLICY:
Commerdal General Liability
POllCYIAPPlICATIONlBINOER NO.: CLS1330620 Tvo~t
EFFECTIVE DATE OF NOTICE:
11130/2009 12:01 AM
(DATE) (HOUR-STANDARD TJt.lE AT THE ADDRESS OF THE INSURED)
DATE OF MAILING: 10/28/2009
NAME AND AOORESS DF AGENTIBROKER:
Reinhold! & O'Harra Insurance
518 Washington St
Ashland OR 97520
NAME ANO .
ADDRESS
OF INSURED
Briscoe Artwing
PO Box 3194
ASHLAND
OR
97520
(Speciflc 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 eflective on and after the hour and date mentioned above. Th~ notice ~ being provided to you as you have
been provided with a certificate of insurance on the ebove policy. Any interest you may have in the above policy ~ terminated.
\i_-",_~ D.:
AUTHORIZED REPRESENTATM:
NAME AND.
ADDRESS OF
CERTIFICATE
HOLDER
City of Ashland
20 E Main Street
Ashland
DR
97520
(E)GU ~)(E<l.~) UNIFORM
CERTIFICATE HOLOER'S COPY
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