31B-064 (3) 3 { q PHILADELPHIA INDEMNITY INSURANCE COMPANY
00 // 1-877-438-7459
ONE BALA PLAZA, SUITE 100
BALA CYNWYD PA 19004
NOTICE OF CANCELLATION OF INSURANCE
Named Insured&Mailing Address: Producer:0016023
CLARKE SCHOOL FOR THE DEAF BERKSHIRE INSURANCE GROUP
45 ROUND HILL RD P. O. BOX 4889
NORTHAMPTON MA 01060-2123 PITTSFIELD MA 01201
Policy No.: PHPK1845400
Type of Policy: PACKAGE
Date of Cancellation: 01/16/2019; 12:01 A.M. Eastern Time at the mailing address of the Named Insured.
We are cancelling this policy. Your insurance will cease on the Date of Cancellation shown above.
The reason for cancellation is the occurrence, after the effective date of the policy, of nonpayment of premium.
This cancellation will not take effect if the full amount due is paid prior to the effective date of cancellation. The
amount due is$4482.50
This policy provides fire and extended coverage insurance on your property. You should contact your agent
concerning coverage through another insurer, or your eligibility for coverage through the Massachusetts
Property Insurance Underwriting Association, Two Center Plaza, 8th Floor, Boston, MA 02108-1904.
Your interest in this policy as an"insured" or other party of interest is being cancelled effective 01/16/2019;
12:01 A.M. Eastern Time at the mailing address of the named insured.
Date Mailed:
2nd day of January, 2019
Additional Insured 11(4t�
CITY OF NORTHAMPTON
212 MAIN ST
NORTHAMPTON MA 01060-3583 MISSY LYNCH
MACC19NONPMNT
FORM#CC9697191215MA32018 01012019MYNY
ODEN 3 0.18.12a Copy for Additional Insured Page 1 of 1
PHILADELPHIA
INSURANCE COMPANIES
A Member of the Tokio Marine Group
One Bala Plaza,Suite loo,Bala C}uw d,Penusplvania 19004
0006626-0017939 SCOM 001 760330
CITY OF NORTHAMPTON
Is212 MAIN ST
NORTHAMPTON MAO 1060-3583
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