NOTICE OF CANCELLATION
Old Dominion Insurance Co.
PO Box 2004
FLORIDA
NOTICE OF CANCELLATION
AGENT: 090168 STATE: 09
AGENT PHONE: 727 595 2529
Keene, New Hampshire 03431
PLEASE READ CAREFULLY
BPG15254
BUSN OWNER
CANCELLATION/NON-RENEWAL EFFECTIVE
110 DAY YR
12/23/02 12:01 A.M.
TOTAL DUE
$467.70
MIN. DUE
$467.70
POLICY NUI1BER
POLICY TYPE
DATE OF MAILING: 12/05/02
G 102 602 602
MORTGAGEE/LIENHOLDER CACG15254
CITY OF CLEARWATER
112 SOUTH OSCEOLA AVE.
CLEARWATER, FL 33756
ANY EXCESS PREI1IUI1 (IF NOT TENDERED) WILL BE REFUNDED ON DEI1AND
F/CM
INSURED
PICKLES PLUS TOO INC
320 CLEVELAND STREET
CLEARWATER, FL 33758
***IMPORTANT INFORMATION REGARDING YOUR INSURANCE***
- ,_. _u _..._"
DEAR POLICYHOLDER: YOUR BUSINESS IS IMPORTANT TO US!
HOWEVER, OUR RECORDS INDICATE THAT WE HAVE NOT RECEIVED YOUR PAYMENT
DUE 11/24/02. IF WE DO NOT RECEIVE PAYMENT, YOUR POLICY WILL BE
CANCELLED ACCORDING TO POLICY PROVISIONS ON THE CANCELLATION/NON-
RENEWAL EFFECTIVE DATE AND TIME SHOWN ON THIS NOTICE.
TO PREVENT THIS FROM HAPPENING, PLEASE FORWARD THE MINIMUM DUE SHOWN
ABOVE WITHOUT DELAY. THIS MINIMUM PAYMENT INCLUDES THE PAST DUE
AMOUNT, YOUR NEXT SCHEDULED INSTALLMENT, AND ALL APPLICABLE SERVICE
FEES. THIS WILL BRING YOUR ACCOUNT UP TO DATE. AS LONG AS YOUR
MINIMUM PAYMENT IS RECEIVED BEFORE THE CANCELLATION/NON-RENEWAL
EFFECTIVE DATE AND TIME SHOWN ON THIS NOTICE, YOUR COVERAGE WILL
CONTINUE WITHOUT INTERRUPTION.
A REINSTATEMENT NOTICE WILL BE SENT TO YOU WHEN WE RECEIVE YOUR
PAYMENT. REINSTATEMENTS ARE CONDITIONAL UPON BANK ACCEPTANCE OF
PAYMENTS BY CHECK.
WE HOPE THIS REMINDER WILL PREVENT A LAPSE IN YOUR COVERAGE. WE
VALUE OUR RELATIONSHIP WITH YOU. IF YOU HAVE ANY QUESTIONS, PLEASE
CONTACT YOUR AGENT AS SOON AS POSSIBLE.
60-7622 <10/92)
IMPORTANT: STATE REGULATIONSI IF ANY APPLYI ARE ON REVERSE SIDE
MORTGAGEE COPY
IMPORTANT INFORMATION
Concerning Your Motor Vehicle Insurance
If the motor vehicle insurance policy being cancelled or non renewed provides personal injury
protection benefits and property damage liability insurance, Florida law requires that we
report such action to the Department of Highway Safety and Motor Vehicles within 45 days
from the effective date of the cancellation or nononrenewa1.
Failure to maintain personal injury protection and property damage liability insurance on a
motor vehicle when required by law may result in the loss of your motor vehicle registration
and driving privileges in this state. Should your registration and driving privileges be
suspended, the following fee will be charged for the reinstatement of your motor vehicle
registration and/or driver's license (if both your registration and license are suspended,
only one reinstatement fee shall be charged to reinstate the registration and license):
$150 - first reinstatement
$250 - second reinstatement
$500 - each subsequent reinstatement during 3 years following the first reinstatement.
If you do not have a second reinstatement within 3 years after the initial reinstatement,
the reinstatement fee will be $150 for the first reinstatement after that 3 year period.
Old Dominion Ins Co
PO Box 2004
Keene, New Hampshire 03431
12/07/02
Busn Policy BPG15254
MORTGAGEE/LIENHOLDER
INSURED
CITY OF CLEARWATER
112 SOUTH OSCEOLA AVE.
CLEARWATER, FL 33756
PICKLES PLUS TOO INC
320 CLEVELAND STREET
CLEARWATER, FL 33758
Dear Policyholder, Thank you for your payment. Your insurance
coverage has been reinstated and remains in force. Your
reinstatement is dependent upon timely payment being honored
by the financial institution and if payment is not honored by
the financial institution, the policy will terminate on the date
and time shown on the cancellation notice issued for nonpayment
of premium.
00178
Old Dominion Ins Co
AGENCY
090168003
MITCHELL AGENCY INC
14290 WALSINGHAM RD.
LARGO, FL 33774