Laserfiche WebLink
<br />- <br /> <br />r.'" <br /> <br />r , <br />I <br />I <br />I <br /> <br />STATEMENT ACKNOWLEDGING THAT COVERAGE HAS <br /> <br />r' <br />I <br />1 <br /> <br />BEEN PLACED WITH A NON-ADMITTED CARRIER <br /> <br />! ~ <br />I ~ <br /> <br />Per Florida Statute, the insured is required to sign the following E&S disclosure: <br /> <br />The undersigned hereby agrees to place insurance coverage in the surplus lines market and understands <br /> <br />that superior coverage may be available in the admitted market and at a lesser cost. Persons insured by <br /> <br />surplus lines carriers are not protected by the Florida Insurance Guaranty Association with respect to any <br /> <br />I ~ <br /> <br />right of recovery for the obligation of an insolvent unlicensed insurer. <br /> <br />11 <br />L <br /> <br />City of Sunny Isles Beach <br />Named Insured <br /> <br />L <br />[ ~ <br />l~ <br /> <br />Signature of Insured's Authorized Representative <br /> <br />Date <br /> <br />Hiscox on behalf of Certain Underwriters at L10yds of London <br />Name of Excess and Surplus Lines Carrier <br /> <br />Builders Risk <br />Type of Insurance <br /> <br />[ , <br />L <br /> <br />11-1-11 <br />Effective Date of Coverage <br /> <br />L <br />L <br /> <br />r' <br />L <br /> <br />L~ <br /> <br />l_l <br /> <br />9 <br />