HomeMy WebLinkAboutSAINTS TRUCKING - INSURANCE CERTIFICATE (5)N
INTERLINE
WI 00 99 07 06
DATE: 09/01 /2009
WILSHIRE INSURANCE COMPANY
P.O. Box 7006, Lancaster, California 93539-7006
TICE OF CANCELLATION / NONRENEWAL
To ALL Insureds, Loss Payees, and Other Interests named in the Policy shown below:
Additional Interest Policy Number:
FORT COLLINS, CITY OF BA2494623 57 02
DIRECTOR OF PURCHASING
215 N MASON, 2ND FLR
FORT COLLINS. CO 80522-0000
We are notifying, you, lin accordancewith the Terms and -Conditions of the policy shown above, that your policy will
cease at 12:01 a.m. Standard Time at the first Named Insured's Mailing Address on the date shown below:
CANCELLATION / TERMINATION DATE OF POLICY:
10/01 /2009
PREMIUM ADJUSTMENT: If this policy is cancelled and the premium has not been paid, the earned premium due
and payable shall be computed as provided in the policy, and demand is hereby made for payment thereof:. If
premium has been paid, the excess paid premium above the earned premium, if any, if not tendered with this
Notice of Cancellation/Nonrenewal; will be refunded as soon as practicable after cancellation becomes effective.
The following,' when applicable,, have also been AVAILABILITY OF OTHER INSURANCE
notified (by separate notice) Certificate Holder(s), We are notifying you that we are cancelling your policy for
Additional Insuredsor Interest(s), and all Commercial Automobile- insurance. Other insurance is
Domestic and Foreign Motor Carrier Regulatory possibly available through your agent, another insurer or
Entities. through the Automobile Insurance Plan. For additional
information, please contact your insurance agent.
Named Insured:
SAINTS TRUCK
4502 HIBISCUS
FORT COLLINS,
Countersigned
Policy Issued through
TRUCKWRITER
1510 GLEN AY
LAKEWOOD,jC
NG, LLC
ST
CO 80526-0000
ster. California on 09/01 /09 az'--t A
Authorized Representative
Countersignature
gency: Producer Code: 000300001
OF,COLORADOING
-
DR STE 6
;80215-3Q51-
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09/01 /2009
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