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<br />WESTERN NATIONAL ASSURANCE COMPANY <br />9706 4TH AVENUE NE <br />STE 200 <br />SEATTLE WA 98115 <br />NOTICE OF CANCELLATION OF INSURANCE <br />Named Insured & Mailing Adtlress: Producer: 831 <br />DREAMLAND SKATEPARKS LLC <br />PMB 334 _ KPD INSURANCE INC <br />960 SE HWY 101 Po Box 7sa <br />LINCOLN CITY OR 97367 SPRINGFIELD OR 97477 <br /> Reference: & ON AUTO POLICY CPP 0012542 <br /> Policy No.: CPP 0012567 <br /> Type of Policy: PACKAGE <br />_ <br />I Date dfCancellatiori: 0 412 512 01 0;-12:01 A:M.-Local Time at the mailing'"address <br />Our records indicate you have a Certificate of Insurance evidencing coverage under the above policy. This is <br />your notice that this policy is being cancelled effective 0412 512 01 0; 12:01 A.M. Local Time at the mailing address <br />of the named insured. <br />Your interest in this policy is being cancelled effective 06!12/2010; 12:01 A.M. Local Time at the mailing <br />address of the named insured. <br />ac~~-c~.~d <br />Date Mailed: <br />27th day of April, 2010 <br />Certifcate Holder <br />CPP 0012567 CID 262201 <br />CITY OF EUGENE <br />ATTN HEATHER NELSON <br />1820 ROOSEVELT BLVD <br />EUGENE OR 97402 <br />FORM# CC98970203040R72000 <br />ODEN 3.0.10.02a <br />Copy for Certifcate Holder <br />~ , <br />RICHARDS, STEVE <br />ORCC79NONE APP <br />04272010SYNN <br />Page 1 of t <br />