Insurance - Robin B. Hamers & Associates - GL Reinstatement 2018-0701TRAVELERS 000sa-oi
707 WEST MAIN AVENUE RECEIVED
SUITE 300
SPOKANE WA 99201
JUN 2 5 2018
Costs Mess 3'antrn:••: Otsrrict
COSTA MESA SANITARY DISTRICT
290 PAULARINO AVENUE
COSTA MESA CA 92626
REINSTATEMENT NOTICE
Please take notice that the Policy designated below has been reinstated as of the effective date of the reinstatement
stated below, notice of cancellation heretofore issued being hereby withdrawn as null and void.
POLICY NUMBER: 680-1J616034-18-47
ISSUE DATE: 06/20/2018
NAME AND ADDRESS OF INSURED
PRODUCER OR AGENT
ROBIN B. HAMERS & ASSOCIATES,
SELECTSOLUTIONS INS LLC DGW54
INC.
234 E 17TH ST
ISSUING OFFICE
STE 205
COSTA MESA CA 92627
SPECIALIST A&E 21X
EFFECTIVE DATE OF THIS NOTICE
VEHICLE IDENTIFICATION
07/01/18
(Comdete for Auto Policies or Coverages Only)
LOCATION
(Com,dete for Fire Policies or Fire 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;
❑ A MORTGAGEE
THIS NOTICE IS GIVEN ONLY BY THE
COMPANY OR COMPANIES WHICH ISSUED
THE POLICY DESIGNATED ABOVE.
Page 1 of 1
CN 00 3C 03 94
TRAVELERSJ�
707 WEST MAIN AVENUE
SUITE 300
SPOKANE WA 99201
00715-01
COSTA MESA SANITARY DISTRICT
290 PAULARINO AVENUE
COSTA MESA CA 92626
RECEIVED
JUN 18 2018
Costa Mesa Sanitary District
❑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-IJ616034-18-47 I ISSUE DATE: 06/12/2018
NAME AND ADDRESS OF INSURED
ROBIN B. HAMERS & ASSOCIATES,
INC.
234 E 17TH ST
STE 205
COSTA MESA CA 92627
EFFECTIVE DATE OF THIS NOTICE
07/01/18
LOCATION
(Complete for Fire Policies or Fire Coverages ONLY)
PRODUCER OR AGENT
SELECTSOLUTIONS INS LLC DGW54
ISSUING OFFICE
SPECIALIST A&E 21X
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;
❑ A MORTGAGEE
THIS NOTICE IS GIVEN ONLY BY THE
COMPANY OR COMPANIES WHICH ISSUED
THE POLICY DESIGNATED ABOVE.
Page 1 of 1
CN 00 3A 03 94