HomeMy WebLinkAboutROBINSON CONCRETE - INSURANCE CERTIFICATESTATE NATIONAL INSURANCE COMPANY, INC.
POST OFFICE BOX 9
CHANDLER OK 74834
NOTICE OF CANCELLATION OF INSURANCE
Named Insured & Mailing Address:
ROBINSON CONCRETE INC
16522 KEYSTONE BLVD STE N
PARKER CO 80134-3302
Producer: 30405 01017
MACHANN INSURANCE AGENCY
11160 NO HURON, STE 36
NORTHGLENN CO 80234
Policy No.: CSP0070105
Type of Policy: PACKAGE INCLUDING AUTO
Date of Cancellation: 08/31/2008; 12:01 A.M. Local Time at the mailing address of the Named Insured.
We are cancelling this policy. Your insurance will cease on the Date of Cancellation shown above.
The reason for cancellation is NON PAYMENT - AGENT REQUEST
This policy provides auto liability coverage. You should contact your agent or any licensed agent about your
possible eligibility for coverage through the Colorado Assigned Risk Plan.
Excess premium, if not tendered, will be refunded no more than forty-five days after the effective date of the
termination.
Your interest in this policy as an "insured" or other party of interest is being cancelled effective 08/31/2008;
12:01 A.M. Local Time at the mailing address of the named insured.
Additional Insured
CITY OF FT. COLLINS
PO BOX 580
FT COLLINS CO 80532
Date Mailed:
21st day of August, 2008
T� 0'.
CIMI VICE PRESIDENT
COCC36NONEAPP
FORM# CC96970111 C052001 08212008SYNN
CDEN 3.0.08.08a Copy for Additional Insured Page 1 of 1