CANCELLATION TERMINATION NOTICECANCELLATION /TERMINATION NOTICE
Third Party Copy
CERTHOLDER
Account No. 053 -773 -8
Date: 08/26/2013
Insured:
POWER ELECTRIC SERVICES INC
4714 E HILLSBOROUGH AVE
TAMPA, FL 33610
Page 1 of 1
Place of Issue:
FEDERITED
INSURANCE r
121 East Park Square
PO Box 328
Owatonna, MN 55060
Cancellation/Termination of each policy listed below was requested by the insured.
According to contract language in the policies listed below, we will continue to protect your interest as a
mortgagee, additional insured, or a loss payee through the date and time of day shown below.
Policy
Number
9001438
9001500
9000418
Policy Type
Commercial Package Policy
Umbrella
Worker's Compensation
Standard time at the designated business premises.
CITY OF CLEARWATER
PO BOX 4748
CLEARWATER, FL 33758 -4748
Policy
Cancellation/Term ination
Date
08/09/2013
08/09/2013
08/09/2013
Loss Payee/
Mortgagee/
Additional Insured/
Certificate Holder
Time of
Policy
Cancel lation /Termination*
12:01 a.m.
12:01 a.m.
12:01 a.m.
FEDERATED MUTUAL INSURANCE COMPANY. FEDERATED LIFE INSURANCE COMPANY. FEDERATED SERVICE INSURANCE COMPANY.
MFO-40 (07 -09) HOME OFFICE: OWATONNA, MINNESOTA 55060 1- 888 - 333 -4949