HomeMy WebLinkAboutPark Engineering, Inc. 04.01.2025 V3TRAVELERJam
000061 - 01
PO Box 64095
St. Paul, MN 55102-0095
CITY OF LOS ALTOS
ATTN RICHARD CHIU
26379 FREMONT RD
LOS ALTOS HILLS CA 94022
0 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 .
F-] 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 thereunder.
F-1 AMENDMENT NOTICE. Please take notice that, effective on the date stated below, the Policy designated below
has been amended as follows:
â NON -RENEWAL NOTICE. Please take notice that we have advised the insured that this Policy will not be
renewed.
F] REWRITE NOTICE. Please take notice that the Policy designated below has been canceled; however, it is being
rewritten.
POLICY NUMBER: BA -45313663-24-47-G . I ISSUE DATE: 04-10-25
NAME AND ADDRESS OF INSURED
--------- PARK ENGINEERING, ---INC ---.------- ---
372 VILLAGE SQ
ORINDA CA 94563
I PRODUCER OR AGENT
BRICK INSURANCE AGENCY
ISSUING OFFICE
RETAIL A&E 21W
DMT47
EFFECTIVE DATE OF THIS NOTICE VEHICLE IDENTIFICATION
0
0 04-01-25 (Complete for Auto Policies or Coverages Only)
0
0
0
0 LOCATION
0
0
N (Complete for Fire Policies or Fire Coverages ONL Y)
0
T_
o
00
WRITTEN NOTICE IS HEREBY GIVEN TO YOU AS:
F_v_1
THE PERSON TO WHOM AN INSURANCE CERTIFICATE WAS ORIGINALLY ISSUED OR A BANK
OR FINANCE COMPANY;
-1 Fâ AN ADDITIONAL INSURED UNDER THE TERMS OF THE POLICY;
F-1 A MORTGAGEE
THIS NOTICE IS GIVEN ONLY BY THE
COMPANY OR COMPANIES WHICH ISSUED
THE POLICY DESIGNATED ABOVE.
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