HomeMy WebLinkAbout5495 - Olympic AmbulanceNOTICE OF CANCELLATION
00010
DATE OF MAILING: 0 8/13/21
NOTE: MINIMUM DUE REPRESENTS ONLY THE AMOUNT
DUE AND UNPAID AS OF THE'DATE OF MAILING'.
PRODUCER
646—
POLICY NUMBER
CPW 6873977-1
CANCEL EFFECTIVE DATE
09/13/21
PAST DUE AMOUNT
160.40
CURRENT INSTALLMENT
14204.00
ADDL INSURED
CITY OF BREMERTON
C/0 CITY CLERK CITY HALL
345 6TH ST SUI E 100
BREMERTON WA 98337
POUCYPERIOD: O7/15/21 TO O7/15/22
MINIMUM DUE
14364.40
INSURED
TOTAL OUTSTANDING BALANCE
71484940
OLYMPIC AMBULANCE INC AND
OR BREMERTON AMBULANCE IN
601 HENDRICKSON RD
SEQUIM WA 98382
issuEo av: NATIONAL CONTINENTAL INS .
CAIP UNDERWRITING — WA
RELATED
TO
POLICY
COVERAGES
�UESTIONS
R
BILLING
CALL:
1-800-937-2247
Premium due 08/10/21 is still unpaid. Therefore, you are hereby notified in accordance with the terms and conditions
of the above mentioned policy, that your insurance will cease from the hour and date mentioned above due to non payment
of premium. No further notice will be sent. TO KEEP YOUR POLICY IN FORCE...Make payment of the MINIMUM DUE to the
company BY THE CANCEL EFFECTIVE DATE shown above. Upon receipt of your payment, we will send you a
Reinstatement Notice. If you have any questions, please contact your producer or company.
RECEIVEp R EIVED
AU6 2 p ppZ, AUG 1 Z�
City Of grem
City Attorneys e offn
ice
Attorneys
ADDL INSURED SEE IMPORTANT NOTICE ON SACK
DETACH AND RETURN THIS PORTION WITH YOUR PAYMENT
Iclsx)
ARCNXF51 02/26/95
MINIMUM DUE
1 INDICATE CHANGE OF ADDRESS ON REVERSE SIDE. TOTAL OUTSTANDING BALANCE
2 WRITE YOUR POLICY NUMBER ON CHECK OR MONEY ORDER. 14364.40 71484.40
POUCYPERIOD: O7/15/21 TO O7/15/22
MAKE PAYMENT TO:
NATIONAL CONTINENTAL INS. OLYMPIC AMBULANCE INC AND
CAIP UNDERWRITING — WA OR BREMERTON AMBULANCE IN
P.O. BOX 94921 601 HENDRICKSON RD
CLEVELAND OH 44101 SEQUIM WA 98382
IF YOU DO NOT KEEP YOUR LIABILITY INSURANCE IN FORCE DURING THE
ENTIRE REGISTRATION PERIOD, YOUR REGISTERING AND DRIVING
PRIVILEGES WILL BE SUBJECT TO SUSPENSION. BY LAW YOUR INSURANCE
CARRIER IS REQUIRED TO REPORT SPECIFIC TERMINATION INFORMATION
TO THE MOTOR VEHICLE DEPARTMENT.
Appeal to Automobile Insurance Plan Governing Committee: As your policy was one obtained through your state
Automobile Insurance Plan, you are hereby advised, regarding this notification of cancellation, that you may have the right to
appeal to the governing committee of the Plan in your state:
Governing Committee
Washington Automobile Insurance Plan
PO Box 6530
Providence RI 02940
IF AN APPEAL OF A CANCELLATION IS GOING TO BE MADE TO THE INSURANCE DEPARTMENT, A COPY OF THIS
CANCELLATION NOTICE SHOULD ACCOMPANY THE APPEAL.
WACNI69 1 01/03/ 19
IMPORTANT: IF YOUR ADDRESS HAS CHANGED PLEASE SHOW THE NEW ADDRESS BELOW:
STREET
CITY OR TOWN
STATE, ZIP
PLEASE CONTACT YOUR AGENT CONCERNING ANY OF THE FOLLONIING CHANGES NOT ALREADY REPORTED TO THE COMPANY:
1. CHANGE IN USE OF AUTOS) 2. CHANGE OF AUTOS) 3. CHANGE OF OPERATORS) 4. CHANGE OF COVERAGE