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, ; : �.���r <br /> ; - ,.�_ :_.:.y_ � -.,.: . ..�� <br />;� . - _ <br /> M ' <br /> 91'- 1�64t1�e <br /> ,� <br /> ---- ---- ------- - - -- - --- -------- - - -- <br /> �j '��j��� NOTICE OF�I�E�NvDrI�NG CANCELLATION <br /> � ���� 219-3 S 3-0_� Raaaon for C.anq�qon <br /> � OS/28/97 � �p�ry�M���� <br /> ' Totai Arnounl Due - 50,297.90 Or lnstatirtwrtt Pss!Du� <br /> - --- _. ----- —(� F.o r. S/2�/4 L <br /> P1ace of Issue: �� '.- <br /> i P.O. BOX 328 �EF�.<r�Y. p�►� <br /> ' LEUIS C�NS'!'RU�TION CDH:' ' ��T�A, � 55060 <br /> � DBA � " -1i�353 0 <br /> t 4110 HORSESHO£ YL ICCATIGN OF WSURfD PROPERTY <br /> '� � CRAND ISLAND �tE r>ehf:� If OTF�R THMi PfiWTED ADOftESS <br /> :"� <br /> � <br /> � INSIIRE[)'S NAME f+�lO nn�{�E°;,; � � <br /> �� � � i <br /> � Policy Type i Pot�cy E�led+ve ; Cantsl�ation <br /> • ---------- Mumb�r [late � UaN C�� • Amoxnl Dw <br /> . - --- - ---- ---- <br /> ` COHHERCIAL PACKACt Pot_Ir,Y :o:;, : �5�� . :9� �6;'1aJ97 12_O1 •.■. . y.p45.vo <br /> S„ NORK£RS COMPENSATION 10)37�3 , JS, ; ; :97�G6j14/97 12:01 s.�. 46,252.50 ' <br /> _�-�___�-�. --� i : j <br /> -� �-_-- -��i�_� <br /> �:: /��/`1G Pre ovs6.�la.,�, 14 4�3,i : PREVIOIlS IAIA!!CE <br /> Oy,trll/97 OS/21/97 1073752 COHMERCIAI Pai'KaGE PO�ICV REMEMA�RULICY <br /> 0�11/97 OS/21/97 1073753 OF;KER'S C,MY_NSAiI�N RENEMAL PDiICY <br /> 0�122/97 03/O1/97 � 107375: !CnMMERf.IAi r•n�:r.aGE �oi 1�_Y AO.P15Tk�11T � <br /> , RE.VI�t �l :; . ; k� HI�k <br /> 0��22!47 01/l�ii 77 � !:� ; r5. i t Nnt k ..AGt Y:`; 1CY AQJUSTYEMT <br /> I . � <br /> ' ( ,1 1 ti l i i ..� I UN(S) <br /> � K- Ji;t 6 _i 'eRS RIS► <br /> 1 : <br /> :a� 1Y TRapE COHTR FLOATER <br /> Orj�22/97 03/1!/97 101;,i!�.' 't�OMM'ttci;I�l r�;.�KAGE POLICY ADJt1STMENT <br /> � REVISE 9UILDERS RISK <br /> 05f22/97 03I24/97 I1,?';�;.. �,,�.;MMtni;IAL raCxa6E PoLICY ADJUSTMEHT <br /> i ADD 1 LOCATIOH(S) <br /> � DElE7E 1 LOCATIOl1(S) <br /> 05.'22i97 uailoi97 I1073752 �COHMERCIa� PaCKAGE POLICV ADJUSTMENT <br /> DELETE 3 ��CATION(S) <br /> 05�22/97 04/11/97 1073752 COMMERCIAI P,�CKAGE(POLICY ADJUSTNENT <br /> DtLETE 1 VENICIE(S) <br /> ADD 1 VEHICLECS) <br /> � ADD ADDIT:OHAL IHTERESTS <br /> ' REVISE ADDITIONAL INTERESTS <br /> 07.15/97 06/14/97 1073752 CCNNERCIAI PACKAGE POLICY CAHCELATION <br /> I POLICY CANCELED <br /> 07.15197 06/14/97 1073753 uORKER'S C�MPENSATION CANCELATION <br /> POLICY CANCELED <br /> DEFERftED BILLING PARTICIPATION FEE <br /> 107i7r.9 l�nuurorrn� owrvAaC pn1 n iucT�u�ie� ocu�• <br />