HomeMy WebLinkAbout332904 JAG'S ENTERPRISES INC - INSURANCE CERTIFICATENOTICE OF CANCELLATION, NONRENEWAL OR CONDITIONED RENEWAL
(Colorado)
NAMEAND.
WESTERN HERITAGE INSURANCE COMPANY
ADDRESS
PO BOX 5100
OF INSURANCE
COMPANY
SCOTTSDALE AZ
85261
q
JAG'S ENTERPRISES, INC.
NAMEAND.
7951 W. 28TH STREET
ADDRESS
OFINSURED
GREELEY CO
80634
KIND OF POLICY:
Commercial General Liability
POLICY/APPLICATIONBINDER NO.: SCP0835037 Typist:
SM
EFFECTIVE�Aif OT
O12
D 1211
12:01 AM
(HOUR-STANDPRD TIME AT THE ADDRESS OF THE INSVREQ
DATE OF MAILING: 11/16/2011
NAME AND ADDRESS OF AGENT/BROKER:
RENAISSANCE INSURANCE GROUP
PO BOX 478
WNDSOR CO
80550
(Specific information concerning the cancellation
or nonrenewa has been given to the Insured.)
TO THE ADDITIONAL INTEREST:
You are notified that the above policy is cancelled or nonrenewed effective on and afterthe hour and date mentioned above. This notice is being provided to you as you have
been provided with a certificate of insurance on the above policy. Any interest you may have in the above policy is terminated,
KIC91AXD Ty10 ,4S
NAMEAND.
CITY OF FORT COLLINS
ADDRESS OF
PO BOX 580
ADDITIONAL
INTEREST
FORT COLLINS CO
80524
AUTHORIZED REPRESENTATIVE
(E)GU 402c (Ed. 7-02) UNIFORM INFORV ➢ON SERVICES, INC., so 19G8 ADDITIONAL INTERESTS COPY Page 1 of 1