‭Policy Number:‬‭2020803345‬

‭PO Box 3199 ● Winston Salem NC 27102-3199‬‭Named Insured:‬

‭VALERIE KEHOE‬

‭Policy Period:‬‭12:01 AM‬

‭ ALERIE KEHOE‬
V ‭Encompass Insurance Company‬
‭114 W MAIN ST‬ 2‭ 4 Hour Claim Reporting: 1-888-325-1190‬
‭HERSHEY, PA 17033-2440‬ ‭For Policy Information: 1-888-325-1190‬
‭w‬‭ww.NationalGeneral.com‬
‭Your Agent:‬
‭Selectquote Auto & Home‬
‭6800 W 115th St Ste 2511‬
‭Overland Park KS 66211‬
‭(877) 468-3466‬

‭ OTICE OF CANCELLATION OR‬

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‭NON-RENEWAL‬
1‭ 1/15/2023 - 11/15/2024‬
‭Date of Notice:‬‭12/6/2023‬‭Policy Underwritten By:‬

‭ ENNSYLVANIA LAW REQUIRES THAT YOU BE GIVEN A COPY OF THIS NOTICE.‬

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‭READ IT CAREFULLY.‬

‭ A PERSONAL AUTO NOTICE OF CANCELLATION‬

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‭CANCELLATION TO TAKE EFFECT AT 12:01 AM ON 2/13/2024‬
‭ ou are hereby notified in accordance with the terms and conditions of the above mentioned policy, and in accordance‬
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‭with law, that your insurance will cease at and from the hour and date mentioned above. If premium has been paid,‬
‭premium adjustment will be made as soon as practicable.‬

‭REASON FOR CANCELLATION‬

‭Proof of Signed Application never received‬
‭Important Notice(s):‬

‭ OU HAVE THE RIGHT TO REQUEST THE PENNSYLVANIA INSURANCE COMMISSIONER TO REVIEW THIS‬
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‭ACTION BY THE COMPANY. TO DO THIS, SIGN AND SEND A COPY OF THIS FORM WITHIN 30 DAYS TO THE‬
‭PENNSYLVANIA INSURANCE COMMISSIONER AT:‬

I‭nsurance Department‬
‭Bureau of Consumer Services‬
‭1209 Strawberry Square‬
‭Harrisburg, PA 17120‬
‭Toll Free Consumer Line (877) 882-6388‬
‭Fax: (717) 787-8585‬

I‭ request the Pennsylvania Insurance Commissioner review the cancellation or nonrenewal of or the refusal to write this‬
‭insurance policy.‬
 Valerie Kehoe
‭__________________________________________‬
‭(Signature of Insured)‬

‭Insured Mailing Address‬

‭10681PA (11012015)‬

‭VALERIE KEHOE 114 W Main St‬

‭Hershey, PA 17033-2440‬

‭IF YOU HAVE ANY TROUBLE GETTING NEW INSURANCE, ANY INSURANCE AGENT OR BROKER MAY GET THIS‬
I‭NSURANCE FOR YOU THROUGH THE PENNSYLVANIA AUTOMOBILE INSURANCE PLAN (WHICH HANDLES‬
‭ASSIGNED RISKS) IF YOU ARE ELIGIBLE FOR IT.‬

‭ OU MUST OBTAIN COMPUSLORY AUTOMOBILE INSURANCE COVERAGE IF YOU OPERATE OR REGISTER A‬

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‭MOTOR VEHICLE IN THIS COMMONWEALTH. WE WILL NOTIFY THE DEPARTMENT OF TRANSPORTATION THAT‬
‭THE INSURANCE IS BEING CANCELLED OR NONRENEWED.YOU MUST NOTIFY THE DEPARTMENT OF‬
‭TRANSPORTATION IF YOU HAVE REPLACED COVERAGE. FAILURE TO DO SO COULD RESULT IN THE‬
‭SUSPENSION OF YOUR OPERATOR’S PRIVILEGE AND REVOCATION OF YOUR MOTOR VEHICLE‬
‭REGISTRATION.‬

‭ HEN COVERAGE IS BEING TERMINATED DUE TO NON-RESPONSE TO A CITATION IMPOSED UNDER 75 PA.C.S‬
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‭1533(RELATING TO SUSPENSION OF OPERATING PRIVILEGE FOR FAILURE TO RESPOND TO CITATION) OR‬
‭NONPAYMENT OF A FINE OR PENALTY IMPOSED UNDER THAT SECTION, COVERAGE SHALL NOT TERMINATE‬
‭IF YOU PROVIDE THE COMPANY WITH PROOF THAT YOU HAVE RESPONDED TO ALL CITATIONS AND PAID ALL‬
‭FINES AND PENALTIES ON OR BEFORE THE TERMINATION DATE OF THIS POLICY. You have the right to know the‬
‭information on which we based our decision, a copy of that information and the identity of its source. If you believe any of‬
‭this information is incorrect, you may ask us to correct, amend or delete such information by mailing your request to our‬
‭address provided above.‬

‭If you have questions regarding this notice, please contact your agent.‬

‭Authorized Signature‬