HomeMy WebLinkAboutPark Engineering Inc 04.10.25 V2.A.
TRAVELERS J 000039 - 01
PO Box 64095
St. Paul, MN 55102-0095
CITY OF LOS ALTOS ATTN RICHARD CHIU
26379 FREMONT RD
LOS ALTOS HILLS CA 94022
❑x 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 there under.
❑ 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: 680-lP219042-24-47 ISSUE DATE: 04/10/2025
NAME AND ADDRESS OF INSURED PRODUCER OR AGENT
PARK ENGINEERING, INC.
372 VILLAGE SQ BRICK INSURANCE AGENCY DMT47
ORINDA CA 94563
a EFFECTIVE DATE OF THIS NOTICE
0 04/01/25
0
LOCATION
0
(Complete for Fire Policies or Fire Coverages ONLY)
s
ISSUING OFFICE
RETAIL A&E 21W
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;
1`��:..i
❑ A MORTGAGEE
THIS NOTICE IS GIVEN ONLY BY THE
COMPANY OR COMPANIES WHICH ISSUED
THE POLICY DESIGNATED ABOVE.
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