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HomeMy WebLinkAbout128575 GRAY OIL COMPANY INC - INSURANCE CERTIFICATE (2)CANCELLATION/TERMINATION NOTICE
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Insured:
GRAY OIL COMPANY INC
804 DENVER AVE
FORT LUPTON, CO 80621
12ES15
Third Partyy Copy
CERTHOLDER
Account No.316-453-0
Date: 10/15/2013
Cancel Iation/Termination of each policy listed below was requested by the insured.
Place of Issue:
MEWED
INSURANCE7'
121 East Park Square
PO Box 328
Owatonna. MN 55060
According to contract language in the policies listed below, we will continue to protect your interest as a
mortgagee, additional insured, or a loss payee through the date and time of day shown below.
Policy
Time of
Policy
Cancellation/Termination
Policy
Number Policy Type
Date
Cancellation/Termination'
0640229 Commercial Package Policy
10/01/2013
12,01 a.m.
0640235 Umbrella
10/01/2013
12:01 a.m.
Standard time at the designated business premises.
CITY OF FORT COLLINS
PO BOX 580
FORT COLLINS, CO 80522-0580
Loss Payee/
Mortgagee/
Additional Insured/
Certificate Holder
FEDERATED MUTUAL INSURANCE COMPANY. FEDERATED LIFE INSURANCE COMPANY. FEDERATED SERVICE INSURANCE COMPANY.
MFO-40 (07-09) HOME OFFICE: OWATONNA, MINNESOTA 55060 1-888-333-4949