HomeMy WebLinkAboutInsurance Certificate: Public Works Mgmt (2)
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NOTICE TO L1ENHOLDER/MORTGAGEE/
ADDITIONAL INSURED/CERTIFICATE HOLDER
MARYLAND CASUALTY COMPANY
(Refer to envelope for insurance company address)
CITY OF ASHLAND
20 E. MAIN STREET
ASHLAND
OR 97520-
POLICY NO. IINSUREO PUBLIC WORKS MANAGEMENT, INC.
PAS 02631697
AGENT
UNITED RISK
INSURING COMPANY
MARYLAND CASUALTY 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:
..L. 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 11/26/2009 .
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TO CERTIFICATE HOLDER
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
11/10/2009
Date of Mailing
990028 (3/94)
11llRD PARTY COPY