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Home My WebLink AboutInsurance Certificate: Public Works Mgmt ......... ......... ......... - - - ......... ......... ......... - - - ......... - ......... ......... . co "" .... = N <=> co <=> ~ . 440 NOTICE TO L1ENHOLDER/MORTGAGEE/ ADDITIONAL INSURED/CERTIFICATE HOLDER MARYLAND CASUAL TV COMPANY (Refer to envelope for insurance company address) CITY OF ASHLAND 20 E. MAIN STR ASHLAND OR 97520- POLICY NO. IINSURED PUBLIC WORKS MANAGEMENT, INC PAS 02631697 AGENT UNITED RISK INSURING COMPANY MARYLAND CASUAL TV COMPANY REFERENCE TO LIENHOLDER: You are hereby notified that the agreement under the Loss Payable Clause payable to you as Lienholder which is part of the above policy, issued to the above insured, has been or will be cancelled or nonrenewed in accordance with the conditions of the policy. Your interest under this policy ceases effective TO MORTGAGEE The Mortgagee Agreement in the .above mentioned policy has been or will be cancelled or nonrenewed. Your interest under this policy ceases effective TO ADDmONAL INSURED: This is to notify you that the above captioned policy which names you as an Additional Insured has been or will be cancelled in accordance with the conditions of the policy. Your interest under this policy ceases effective TO CERTIFICA 1E HOLDER .lL. This is to notify you that the above captioned policy for the above named insured has been or will be cancelled. Your interest in this policy ceases effective 11/03/2009 11/10/2009 Date of Mailing 990028 13/94) lilt RD PARTY COPY