HomeMy WebLinkAbout128365 NATIONAL RESEARCH CENTER INC - INSURANCE CERTIFICATE (12)Sl8tehrM State Farm Fire and Casualty Company
3 Ravinfa Drive
Atlanta GA 30346-2117
AT 1 M-20- 2386-FAI65
W4869 0005
CITY OF FORT COLLINS
3000 LAPORTE AVE
FORT COLLINS CO 80521
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ACKNOWLEDGMENT OF
CANCELLATION REQUEST
Office
(POLICY NUMBER:96-05-B398-8
DATE CANCELED: APR 14 2020
RETURN PREMIUM: None
TO: ❑ INSURED ❑ MORTGAGEE []OTHER
Dear Policyholder,
As Fequested, this policy has been canceled effective"12:01 a.m. (or the time which is required by state law) as of the Date
Canceled shown above. We thank you for giving us the opportunity to provide this insurance.
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'The return premium (if any) is being handled through State Farm Payment Plan - Account # 1227123720
Insured:
POLICY CONFLUENCE INC
DBA NATIONAL RESEARCH
2955 VALMONT RD STE 300
BOULDER CO 80301-1360
Agent: JEFF OGBURN CLU
Telephone: (303) 530-0404
01
Location:
2955 VALMONT RD STE 300
BOULDER CO
80301-1360
SFPP No: 1227123720
DATE PROCESSED
JUN 04 2020
4869 AIN
537-147.12 09.11-2013 (o1f3122g)
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