2000-02-17_GENERAL DOCUMENTS - C1981048

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FEVERATED INSURANCE®`w NOTICE OF IMPENDING CANCELLATION ADDITIONAL INSURED's Copy I _ Account No. 309-128-7 Reason for Cancellation Producer: PARK AVENUE INS 8-733 Date 02/17/00 Nonpayment of Premium CST 805 Total Amount Due Or Installment Past Due Place of Issue: P.O. BOX 35910 PURGATOIRE VALLEY CONSTRUCTION 309-128-7 PHOENIX, AZ 85069 117 PINE ST TRINIDAD CO 81082 LOCATION OF INSURED PROPERTY TRI IF OTHER THAN PRINTED EL61VED 2 2 2000 INSURED'S NAME AND ADDRESS ;;;;lion of Minerals&Geology Policy Type Policy Effective Cancellation Time of * Amount Due Number Date Date Cancellation COMMERCIAL PACKAGE POLICY 624609 03/20/99 03/05/00 12:01 A.M. UMBRELLA 632427 08/24/99 03/05/00 12:01 A.M. EACH POLICY SHOWN ABOVE WILL BE REINSTATED IF PAYMENT IS RECEIVED AT OUR OFFICE BY THAT POLICY'S CANCELLATION TIME AND DATE. * Standard time at the designated business premises. Your interest in each policy described above is cancelled as of the date and time shown above, according to the policy. No coverage will be provided to any party under a policy described above or its Mortgagee Clause or Loss Payee Clause as of the cancellation date and time shown above. The excess paid premium above the earned premium for the expired time (if not tendered) will be refunded. We will reinstate each policy and continue your insurance in force if the AMOUNT DUE shown above plus any refund - check sent with this notice is received at our office by the cancellation date shown for that policy. If payment is by check, reinstatement is conditional upon final acceptance of the check by the bank upon which it Is drawn. MORTGAGEE,LOSS PAYEE OR SERVICE AGENT DIVISION OF MINERALS & 309-128-7 GEOLOGY BY �. 1313 SHERMAN ST ROOM 215 DENVER CO 80203 -- TREASURER FEDERATED.�AUTUAL INSURANCE COMPANY.FEDERATED LIFE INSURANCE COMPANY.FEDERATED SERVICE INSURANCE COMPANY F10-119 09-90 C HOME OFFICE:OWATONNA MINNESOTA.55060 li