NOTICE OF CANCELLATION OF INSURANCENATIONAL CASUALTY COMPANY
C/O K & K INSURANCE GROUP, INC.
1712 MAGNAVOX WAY
FORT WAYNE IN 46804
NOTICE OF CANCELLATION OF INSURANCE
Named Insured & Mailing Address: Producer: 5583727
CLEARWATER JAZZ HOLIDAY INC
PO BOX 7278
CLEARWATER FL 33758
SOLACE INSURANCE
RUTH NICHOLS
10125 ULMERTON RD STE 200
LARGO FL 33771
Policy No.: KK00000003927400 /XK00000003927600
Type of Policy: COMMERCIAL GENERAL LIABILITY
Date of Cancellation: 12/28/2013; 12:01 A.M. Local Time at the mailing address of the Named Insured.
We are cancelling this policy. Your insurance will cease on the Date of Cancellation shown above.
The reason for cancellation is NON - PAYMENT OF PREMIUM IN THE AMOUNT OF $18,164.10. IF YOU HAVE
ANY QUESTIONS, PLEASE CONTACT KENDRA DOSSEN AT 1- 800 - 848 -0987 EXT 6135.
PLEASE MAKE CHECK PAYABLE TO: K &K INSURANCE.
PLEASE REMIT PAYMENT TO:
K & K INSURANCE
8580 INNOVATION WAY
CHICAGO IL 60682 -0085
Your interest in this policy as an "insured" or other party of interest is being cancelled effective 12/28/2013;
12:01 A.M. Local Time at the mailing address of the named insured.
Additional Insured
5583735 CJP /11
CITY OF CLEARWATER
PO BOX 4748
CLEARWATER FL 33758
FORM# CC9697FL51995
ODEN 3.0.13.12a
Copy for Additional Insured
Date Mailed:
12th day of December, 2013
FLCC15NONPMNT
12122013MYNY
Page 1 of 1