HomeMy WebLinkAboutGREENBACK LLC - INSURANCE CERTIFICATEl
NAME AND ADDRESS OF INSURANCE COMPANY
SENTINEL INSURANCE COMPANY, LTD
HARTFORD PLAZA
HARTFORD, CT 06115
NAME AND ADDRESS OF INSURED
GREENBACK LLC
2416 STOVER ST
FORT COLLINS, CO 80525
TO LIENHOLDER:
NOTICE OF CANCELLATION
(Colorado)
KIND OF POLICY:
Business Owners
POLICY/APPLICATION/BINDER NO.. 34SBMPLO716
EFFECTIVE DATE
OF NOT ICE:
02/21/12 12:01 A.M.
DATE (HOUR STANDARD TIME AT THE ADDRESS OFTHE INSURED)
DATE OF MAILING.
February 06, 2012
NAME AND ADDRESS
OF AGENT/BROKER.
MOUNTAIN INSURANCE BROKERS
3705 KIPLING STREET SUITE 104
WHEAT RIDGE CO 80033
(Specific information concerning the cancellation
or nonrenewal has been given to the insured.)
The above policy is cancelled or nonrenewed effective on and after the hour and date mentioned above. This notice is being provided to you in
agreement with the Loss Payable Clause on the above policy. Any interest you may have in the above policy is terminated effective on and after the
hour and date mentioned above.
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NAME AND CITY OF FORT COLLINS
ADDRESS OF P.O. BOX 580
LIENHOLDER FORT COLLINS, CO 80522
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