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WrICE Of CANCELLATION, NONRENEML OR
<br /> UNITED sans POW SERVICE Aft CHANGE IN POLICY PREMIUM/COWME
<br /> Received From: postage and )
<br /> INSURANCE Old Repulblic Insurance Company postmark.
<br /> COMPANY IQID OF POLICY.
<br /> POLV NQ:
<br /> One piece of ordinary mail addressed to: CANCELI.Ai10N.EXPIRAT)ON OR CHANGE WILL I&EFFECT AT:
<br /> NAME AND Mid Continent Minerals Corporation. et al August 30, 1"4 12:01 a.&.
<br /> ADDRESS 915 heat 175th strut Como
<br /> OF INSURED 111119neuaod, IL 60430 ONE OF MAIM
<br /> ISSUED THROIIGN AMC OR On AL
<br /> FOR USE AS A 'CEMICATE of MAILW AS PROVIDED IN UCTON 931 OF 7K 'DO"
<br /> 1y1�MAXi�a�, ars.h>« PA lsioi
<br /> E USED FOR DOMUM AND N1 UM1110114 MAR, DOES NOr NOVNIE FOR NSINtANCE "
<br /> CAN&ftMw mortfM®) r' z a>
<br /> CANCEL- You are hereby notified in accordance with the terms and conditions of the above meldiorled pdc%and in accordance with law%that your insurance will cease
<br /> LMON ❑ at and from the hour and date mentioned above for the reaso9s) stated in the Idalpertmit Netlees'section below.
<br /> See the"Imliwitant Notices" section below for other information that may apply.
<br /> El You are hereby notified in accordance with the terms and conditions of the above mentioned po ft and in accordance with law;that your insurance will cease
<br /> at and from the hour and date merrtise d above for the mason(s) stated in the "Important NetlW section below.
<br /> Appeal to do Dkwtor of InsumMce:ff you wish to appeal the reasons)given,eicept for the reason of nol of premium,mail or deliver to the Director
<br /> of Insurance of the State of Illinois,Springfield,Illinois 62767,or State of NNrais Centex Suite Fi-1D0,f00 Y Randolph,Chicago, Illinois 6060L at least 20
<br /> days prior to the effective date of cancellation;a written request for a hearing clearly stating the basis for the bppeal.Costs of the hearing may be assessed
<br /> against the losing party, but shall not arceed$1K
<br /> See the "Important Notices" section below for other information that stay apply
<br /> Premium
<br /> AdRrsfmRt ❑ Unearned premium will be returned to you within 30 days from the date of this notice of cancellation.
<br /> ❑ Unearned premium will be returned to you as soon as practicable after the cancellation becomes effective. i
<br /> ❑ Enclosed is= being the amount of return premium at pro rata for the unexpired term of this policy.
<br /> ❑ A bill for the premium earned to the time of cancellation will be forwarded in due course. L%
<br /> ❑ Otber.
<br /> NOW [j You are nhotlfied in accordance wf fi ibe terms and condi V above el o i� ` with law,that the above mentioned pol'
<br /> hey arise rhqq
<br /> RENEIML will expire effective at and from the hour and date mentioned alie'pp wn� b : - ibe ems)stated in the'Important Notices"
<br /> See the 9Ngwtnt Notices',sectien below
<br /> ❑ You are hereby notified in accordance with the terms and conditions of the above mentioned poij and iR aoeadance with law,that the above mentioned policy
<br /> will expire effective at and fm the hour and dabs mwitiolvid above sobe40kyjMM be nenfgrfed 11,VA he POWN1 stated In the"IaputM Not1cee
<br /> section below. :11r¢:'At. ,4i :t' yA a' g^tryi*.fKdtn;i:°A;±i,4 qe*w*'Ac
<br /> Appeal to the Director of IRsuraRa:ff you wish to appeal the real O Musa,mail err fleliveP tithe N kK*of insurance of the State of Illinois,Springfield,
<br /> Illinois 62167,or State of Illinois Centel;Suite 15100,100 YMest Randolph,Chlcagq Illinois 60601� 2, dogs prig to the a�iraRiorh date,a wrrltah request for
<br /> a hearing, clearly stating the basis for the appeal. Costs of the hearing may be assessed' Ung•party, but shall not coxed SIM
<br /> See the Important Notices" section below for other information that may a
<br /> CHANGE ❑ You are hereby notified in accordance with the terms and conditions of the above mentioned polig%and in accordance with law,that the premium,deductibleW
<br /> IN POLICY and/or coverage applying to the above noted policy will be changed as follows, effective on the data indicated above:
<br /> P20:011 /
<br /> COVERAGE
<br /> IMPORTANT Reason(s)for cancellation or nomenewal(reason(s)stated only ff above marked item indicates -
<br /> NOTICES IkM- et- -- w ,.....a...-- a -+— Et+
<br /> Information on Losses(applies essentially to commercial or business Insurance--not personal or family protection Insurance):Upon your request,we will
<br /> provide you with information on losses you have had during the three previous policy years,except where the policy has been cancelled for non payment of
<br /> premium,material misrepresentations or fraud on the part of the insured.loss information consists of information on closed claims,open claims and any other
<br /> occurrence not included in the open or closed claims information,including date and description at acWrence,and total a".unts of payments and total reserves,
<br /> if any.Mk will provide the requested information within 30 days of your request.(Note:ff you mquI4Oft infadhation and are uncertain whether you qualify
<br /> for the receipt of this information, please contact us for clarification.)
<br /> Information on Losses(applies essentially to personal automobile insurance(not commercial mitonwbNe),except policies Issued under the Illinois Automo-
<br /> bile Insurance Plan):Upon your written request,we will provide you with information on losses you have had during the three previous policy years.Loss informa-
<br /> tion consists of information on closed claims,open claims and any other occurrence not included in the open or closed claims information, including date
<br /> and description of occurrence, and total amounts of payments, if any.We will provide the requested information within 30 days of your request. (Note: If you
<br /> require this information and are uncertain whether you qualify for the receipt of this information, please contact us for clarification.)
<br /> Illinois FAIR Plan Association(applies to policies providing fire,extended coverage and vandalism and malicious mischief insurance,including homeowner's
<br /> Insurance):You have been notified herewith that this Company will no longer be carrying your insurance. ff you wish to replace your policy you should make
<br /> an effort to obtain insurance through another company in the normal market. If you have difficulty in procuring replacement coverage in the normal market
<br /> you possibly may obtain insurance through the Illinois FAIR Plan Association.For further information,please contact your agent or broker or the following office
<br /> of the Association: Suite 2000, 332 S. Michigan Avenue, Chicago, Illinois 60604.
<br /> Automobile Insurance Plan Information(applies ff the policy being cancelled or nonrenewed provides automobile insurance,except Automobile Insurance
<br /> Plan policies):You have been notified herewith that this Company will no longer oe carrying for automobile insurance.You are possiciy etigiuie for automobile
<br /> insurance through another insurer or under the Illinois Automobile Insurance Plan. For further information, please contact your agent or broker.
<br /> ybite Insurance Plan Governing Committee:As your policy was one obtained t' '�e
<br /> robaio11,6 We doove notification of cancellation,that you have the right of appeal to the Governing Committee of the Plan located a: Lu north Wacker Drive
<br /> (Suite 1550), Chicago, Illinois 6060&
<br /> ❑ Consumer Report In compliance with the Fair Credit Reporting Act(Public Law 91.508),you are hereby informed that the action taken above is being taken
<br /> wholly or partly because of information contained in a consumer report from the following consumer reporting agency:
<br /> QIAW aeons
<br /> (DRpNeate of Notice of Cancelhtioe or Nomenewal to LfenhoNer)
<br /> ❑ You are hereby notified that the agreement under the Loss Payable Clause payable to you as Lienholde;which is a part of the above policy,issued to the above
<br /> insured,is hereby cancelled or nonrenewed in accordance with the conditions of the policy,said cancellatiowor nonrenewal to be effective on and after the hour
<br /> and date mentioned above.
<br /> (Duplicate of Notice of Cancellation or Nonrenewal to Mortgagee) DKE OF MAIUNG:
<br /> ❑ Effective at (Standard Time),we hereby cancel or nonrenew the Mortgagee Agreement which is made part of
<br /> the above mentioned policy and also the above mentioned policy issued to the insured named above covering en
<br /> at
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