HomeMy WebLinkAboutIns Cert: Oregon Safe Tree - CANCELLATION
NOTICE OF CANCELLATION
OREGON
INSURANCE RED SffiELD INSURANCE COMPANY
COMPANY: 1411 SW Morrison St, Ste 400, Portland, OR 97205
1(503)226-4146 I Toll Free 1(800)527-7397
TYPE OF POLICY:
COMMERCIAL
INSURED
NAME &
ADDRESS:
OREGON SAFE TREE INC
1257 SISKIYOU BLVD #169
ASHLAND, OR 97520
POLICY NUMBER:
CNT 016518
PLACE OF MAILING:
PORTLAND, OREGON
DATE OF MAILING:
3110/2011
TO ALL INSUREDS, LOSS PAYEES AND INTERESTS NAMED IN THIS POLICY:
YOU ARE HEREBY NOTIFIED THAT ALL COVERAGE UNDER THIS POLICY WILL CEASE AT 12:01 am
EFFECTIVE: 3/2312011
SPECIFIC INFORMATION CONCERNING TillS
NOTICE HAS BEEN GIVEN TO THE INSURED
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Authorized Representative
Agent#: 2111 Phone: (503)620-0230
BEA VERTON- TIGARD INSURANCE
PO BOX 23129
TIGARD. OR 97281-3129
Additional Insured:
CITY OF ASHLAND
20 E MAIN ST
ASHLAND, OR 97520
UN0136(11/02)
ADDITIONAL INTEREST COPY
CANCELLATION CONFIRMATION OF CERTIFICATE
RED SHIELD INSURANCE COMPANY OF INSURANCE OR LOSS PAYABLE CLAUSE
]4]] SW Morrison St, Ste 400, Portland, OR 97205
Additional Insured:
CITY OF ASHLAND
20 E MAIN ST
ASHLAND, OR 97520
Reference No,
I
You hold a Certificate of Insurance, or there is a Loss Payable Clause under which you are an additional
interest or a Payee, in connection with the Policy of Insurance described below, Your Interest was cancelled
for such Certificate or Loss Payable Clause effective as of the date and hour indicated,
TERMINATION EFFECTIVE DATE: 3/23/2011'
at 12:01 AM local time
POLICY NUMBER
CNT016518
Named Insured:
OREGON SAFE TREE INC.
1257 SISKIYOU BLVD #169
. ASHLAND, OR 97520
Producer:' 2111 i
BEA VERTON- TIGARD INSURANCE
PO BOX 23129
TIGARD, OR 97281-3129
RE~?S, A - COMPANY
Authorize" Representative
Date Prepared
At
3/29/2011
PORTLAND, OREGON
UN 00 04 08 05