HomeMy WebLinkAboutWORKWELL OCCUPATIONAL MEDICINE - INSURANCE CERTIFICATEAMERICAN CASUALTY COMPANY OF READING, PA
P.O. BOX 946350
MAITLAND FL 32794-6350
RESCISSION NOTICE
Named Insured & Mailing Address:
3WORK WELL OCCUPATIONAL MEDICINE
205 S MAIN ST
SUITE C
LONGMONT CO 80501
Policy No.: 5085392407
Type of Policy: CNA CONNECT
Producer: 5400472330000
COBIZ INSURANCE INC
821 17TH STREET
DENVER CO 80202
The CANCELLATION notice issued to be effective 05/01/2013 is hereby rescinded.
The CANCELLATION notice issued to be effective 05/01/2013 is hereby rescinded.
You recently received a notice advising this policy was being cancelled effective 05/01/2013. Please be advised
that because we have since received the necessary payment, information or documentation, the cancellation
notice effective 05/01/2013 is rescinded. However, it you have also received a separate cancellation notice with
a different cancellation date and a different reason for cancellation, that notice remains in effect and is not
rescinded by this Rescission Notice. Please contact your agent if you have any questions.
Other Party of Interest
000285
ACCOUNT # 3022802401
CITY OF FORT COLLINS
FINANCIAL SVCS PURCHASING DIVISION
215 N MASON ST, 2ND FL; PO BOX 580
FORT COLLINS CO 80522
Date Mailed:
26th day of April, 2013/
RICHARD A. SMITH _ 1
W
COCS19RSCN_C
FORM# CS01 CO22006 04262013MNNY
ODEN 30.13.02a Copy for Other Interests Page 1 of 1