NOTICE OF CANCELLATION OF GENERAL LIABILITY
OF
General liability
N('ICE OF CANCEL~~~~~N OR NONRENEWj'.
POLICY NO.
DATE OF MAl LI NG
ISSUED THROUGH AGENCY OR OFFICE AT,
KIND Of POLICY
CANCELLATION OR TERMINATION WILL TAKE EFFECT AT,
(DATE) (HOUR-STANDARD TIME)
AGl 2961498
INSURANCE
COMPANY
NAME AND
ADDRESS
OF INSURED
Clearwater, Florlda
12/28/85
12:01 am
12/16/85
The Cincinnati Insurance Company
c/o Shafer-B~ Insurance, Inc.
P. o. Box 1328
Clearwater, Florida 33517
Clearwater High School Band Boosters Assoc., Inc.
P. o. Box 4279
Clearwater, Florida 33518
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Dee 19
1905
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(Specific information concerning the cancellation
or nonrenewal has been given to the Insured.)
TO LIENHOLDER,
You are hereby notified that the agreement under the Loss Payable Clause payable to you as Lienholder, which is a part of the above policy, issued to the above
insured, is hereby cancelled (or terminated) in accordance with the conditions of the policy, said cancellation (or termination) to be effective on and after the hour
and date mentioned above.
INSURANCE. The Cincinnati Insurance Company
COMPANY
NAME AND
ADDRESS
OF LIEN-
HOLDER
City of Clearwater
P. Q. Box 4748
Clearwater, Florida 33518
~~y, I'~~~~:o & SUpp'y
GU 881711 (Ed. l1-R:i) IDwm SAN FRANClscn (C) 1QR,'q;