HomeMy WebLinkAboutGospe Enterprises Inc 09.01.24StateFarm State Farm General Insurance Company
PO Box 2915
Bloomington IL 61702-2915
AT1
M-02-6245-FAD9 N F
000858 0005
THE TOWN OF LOS ALTOS HILLS
ITS ELECTIVE & APPOINTED
Nit";r. OFFICERS, EMPLOYEES, &
`' VOLUNTEERS
1 26379 W FREMONT RD
LOS ALTOS HLS CA 94022-2624
III'�I�'�I�'I��'II�'I�'II����II��II��I�II��IIII�I�I�II��II�IIIII
0
0
0
0
0
s
ACKNOWLEDGMENT OF
CANCELLATION REQUEST
Office
POLICY NUMBER: 97-CQ-QO89-5
�DATE CANCELED: SEP Ol 2024
RETURN PREMIUM: None
To: ❑ INSURED ❑ MORTGAGEE []OTHER
Dear Policyholder,
As requested, this policy has been canceled effective 12:01 a.m. (or the time which is required by state law) as of the Date
Canceled shown above. We thank you for giving us the opportunity to provide this insurance.
Insured:
GOSPE ENTERPRISES INC
Agent: RANDY CHANG INS AGCY INC
Telephone: (650) 919-8880
01
0858 AIV
537-147.12 09-11-2013 (olf3122g)
001
Location:
320 VERANO DR
LOS ALTOS CA
94022-2344
DATE PROCESSED
SEP 13 2024