NOTICE OF CANCELLATION OF INSURANCE
NATIONWIDE INSURANCE
3300 WilLISTON ROAD
GAINESVillE, Fl 32608.3943
D
TELEPHONE: 352-377-8500
JAN UARY 27, 2004
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C I TV OF CLEARWATER
PO BOX 4748
CLEARWATER FL 33758-4748
RECEIVED
FEB 03 2004
OFFICIAL RECORDS AND
LEGISLATIVE SRVCS DEPT
Insured:
CLEARWATER FOR YOUTH INC
1501 N BELCHER RD STE 236
CLEARWATER FL 33765-1339
Policy:
77 PR 018-655-8000 F
Our records indicate that you have an interest in the above insurance policy.
The policy premium is past due and this is advance notice that the policy will cancel for
non-payment of premium on 12:01 A.M. FEBRUARY 7,2004.
_We. will notify_ you if - thepolicy.lsc cancelled for non,paymentoLpremlum..1Lpayment is __._
received, coverage will continue and you WILL NOT receive a final notice of cancellation.
NATIONWIDE MUTUAL FIRE INSURANCE COMPANY
Agent: R.W. MILLER
Telephone: 727-441-9911
RECEIVED
FEB 0 2:'004
RISK MANAGEMENT
886