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2017-08-10_GENERAL DOCUMENTS - C1992080
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2017-08-10_GENERAL DOCUMENTS - C1992080
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Last modified
8/22/2017 1:25:42 PM
Creation date
8/22/2017 10:36:59 AM
Metadata
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Template:
DRMS Permit Index
Permit No
C1992080
IBM Index Class Name
General Documents
Doc Date
8/10/2017
Doc Name
Notice of Cancellation
From
Mid Continent Casualty Company
To
DRMS
Permit Index Doc Type
Insurance
Email Name
RDZ
JRS
Media Type
D
Archive
No
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MID-CONTINENT CASUALTY COMPANY <br /> P.O.BOX 1409 TULSA,OK 74101-1409 <br /> RECrr COMMERCIAL GENERAL LIABILITY POLICY <br /> NOTICE OF CANCELLATION <br /> AUG 10 2017 <br /> Division of Reclamation, POLICY NO. <br /> Mining&Safety <br /> ITEM ONE <br /> NAMED INSURED AND MAILING ADDRESS AGENCY AND MAILING ADDRESS <br /> OAKRIDGE ENERGY INC HIGGINBOTHAM INSURANCE 42-0969 <br /> SEE NAMED INSURED ENDORSEMENT AGENCY, INC -NORTH <br /> 4613 JACKSBORO HWY 500 WEST 13TH STREET <br /> WICHITA FALLS, TX 76032 FORT WORTH, TX 76102 <br /> POLICY PERIOD: From 12/05/2016 to 12/05/2017 at 12:01 a m Standard Time at your Mailing Address shown above. <br /> The above indicated Company of Tulsa, Oklahoma hereby gives you written notice, in accordance with the Policy <br /> Conditions, of the cancellation of Commercial General Liability Policy No. <br /> issued to you. <br /> By virtue of this notice, as issued to you, the Policy is cancelled and all liability of the above indicated Company, under <br /> said Policy, will cease at and from 12:01 a m Standard Time 09/07/2017 <br /> CC: Home Office <br /> Agent <br /> METHOD: <br /> REASON: <br /> TOTAL RETURN PREMIUM: <br /> COUNTERSIGNED AT: TULSA,OK DATE: 08/01/17 BY: ' <br /> Authorized Representative <br /> 08/04/2017 <br /> CAM <br /> MI 90 10(01 98) <br />
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