CANCELLATION NOTICE1 x
A FLORIDA WORKERS COMPENSA ➢ON
JOINT UNDERWRIONC ASSOCIATION, INC.
05060 -AM
2420 LAKEMONT AVE STE 200
ORLANDO FL 32814
CP 01 6640 G6640P0S 13343 05060 P1
CITY OF CLEARWATER
P.O. BOX 4748
CLEARWATER
FL 33758
CANCELLATION NOTICE. Please take notice that the Policy designated below, issued to the insured named
below, has been canceled. Your interest under the Policy is canceled effective on the date stated below.
NOT TAKEN NOTICE. Please take notice that the Insured named below has not accepted the Policy designated
below and therefore no insurance has come into force thereunder.
AMENDMENT NOTICE. Please take notice that, effective on the date stated below, the Policy designated below
has been amended as follows:
NON - RENEWAL NOTICE. Please take notice that we have advised the insured that this Policy will not be
renewed.
REWRITE NOTICE. Please take notice that the Policy designated below has been canceled; however, it is being
rewritten.
POLICY NUMBER: (6FR1 3UB-7D74823-6-1 3 )
ISSUE DATE: 12 -09 -13
NAME AND ADDRESS OF INSURED
MIDFLORIDA ARMORED & ATM
SERVICES INC
4314 WEST DR MLK BLVD
TAMPA FL 33614
PRODUCER OR AGENT
ADCOCK - ADCOCK PROPERTY &
2284N
ISSUING OFFICE
FLORIDA WC JUA 821
EFFECTIVE DATE OF THIS NOTICE
01 -13 -14
LOCATION
(Complete Pr Fire Policies or Fire Coverages ONLY)
VEHICLE IDENTIFICATION
(Complete for Auto Policies or Coverages Only)
WRITTEN NOTICE IS HEREBY GIVEN TO YOU AS:
THE PERSON TO WHOM AN INSURANCE CERTIFICATE WAS ORIGINALLY ISSUED OR A BANK
OR FINANCE COMPANY;
X
AN ADDITIONAL INSURED UNDER THE TERMS OF THE POLICY;
❑ A MORTGAGEE
THIS NOTICE IS GIVEN ONLY BY THE
COMPANY OR COMPANIES WHICH ISSUED
THE POLICY DESIGNATED ABOVE.
Page 1 of 1
CN 00 3A 03 94