HomeMy WebLinkAboutLAZAROS ROOFING - INSURANCE CERTIFICATE (2)269
6000 AMERICAN PICWY • MADISON W1 53783-0001 • PIION. (608) 249 2111
Oclober 22, 2008
+0000269
CITY OF FORT
PO BOX 580
FORT COLLINS
005-316 CDG014
COLLINS
CO 80522
POLICY NUMBER: 05XC4288100000
RE: BUSINESS KEY POLICY
CANCBLATION DATE : 1 1/02/2008
INSURED: LAZAROS ROOFING LLC
3408 MYRTLE S"r
EVANS CO 80620-1818
LOAN NUMBER:
This letter is to notify you of an important change, indicated by the paragraph checked below, in regard to your
interest in this policy.
X 1. The coverages afforded by the above -numbered policy, issued by the company as identified (hereon, will
be canceled on the dates shown above at the time stated in the policy. All liability oil the part of (he
company, as to your interests, if any, will cease as of that dale and lime. Any return premium, which
results 1}om cancelation, has been sent to insured directly or through the agent. Please contact same if
questions arise as a result of any premium payment from an escrow account.
2. We have been informed that you no longer have an interest in the above -numbered policy because your
loan has been satisfied. Therefore, as shown above, we have removed all indications of your interest in
the policy.
3. We have been informed that you are no longer a co-insured under the above numbered policy.
Accordingly, we have canceled your interest as co-insured as shown above.
4. The collision coverage will be removed from this policy on the date shown above at the time stated in
the policy. Comprehensive coverage will remain in Ibrce. The action was taken at the request of the
insured.
5. The comprehensive coverage will be removed from this policy on (he date shown above at the time
stated in the policy. Collision coverage will remain in I'mce. This action was taken at the request of the
insured.
6. The comprehensive and collision coverages, provided by this policy, will be removed on the (late shown
above at the lime staled in the policy. Tbis action was taken at the request of the insured.
7. The policy numbered above is canceled and replaced by Policy NLHnbC1':
Commercial Lines - Farm/Ranch Division
American Family Mutual Insurance Company
AGENT: 005-316 PHONE': 970-484-2881
DANIEL RICHMOND
923 L PROSPECT RD
FORTCOLLINS CO 80525-1110
U•89
Stock Na 07394 Rev. 11/97