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CANCELLATION NOTICE- POOR LOSS EXPERIENCE ,",' I RECEIVED AUG 2 3 1996 (I I I II CITY OF CLEARWATER CITY CLERK DEPT. INTEROFFICE CORRESPONDENCE SHEET' ~ /],1//9~ TO: Susan Stephenson Documents and Records Supervisor City Clerk's Office FROM: Leo W. Schrag.er, ~:i.s~ Man~ .:tAis~~,~ ge~6ifi8a~8 sf IR&araRgS For: SUBJECT: Contract dated Lease dated Special Event Application Miscellaneous Activity Unknown Activity dated dated ~ ? o :tAJ~~~ This office has received the attached ge~_ifi8a~e sf IRBwpaR8~ Fe1~ presumably for the document identified above. 1. This Certificate of Insurance is in compliance with the insurance requirements contained in the contract identified above. 2. This Certificate of Insurance is not in compliance with the insurance requirements in the contract identified above for the following reasons(s) : ,,- X The General Liability limits/Business Auto Liability limits shown are less than the required amounts. The type of General Liability policy provided is a "claims made policy when the contract called for an "occurrence" policy. Worker's Compensation Insurance coverage is not provided. Flood Insurance coverage is not provided. Plate Glass Insurance Coverage is not provided. Boiler and Machinery Insurance coverage is not provided. Business Automobile insurance coverage is not provided. The City has not been provided a copy of the policy(s) . The City is not shown as an additional insured. The Notice of Cancellation is for a &Asrter FerisQ The policy deductible shown is not proyided for by tcuments. . 7Jt.t ~ K 3. This Certificate mayor may not be n compliance with a City contract, but this office cannot offer an opinion because neither contract nor the purpose of the Certificate of Insurance can be identified. cc: Department (If no department is shown, it is because no department can be identified.) NOTICE OF CANCELLATION OR NONRENEWAL .. I (Florida) I Ii KIND OF.OLlCY: COMMERCIAL LINES POLICY NO,: PHPG105087 CANCELLATION OR EXPIRATION WILL TAKE EFFECT AT: PHILADELPHIA INDEMNITY INSURANCE COMPANY 10/01/96 (DATE) 12: 01 AM (HOUR-STANDARD TIME ADDITIONAL INSURED AS RESPECTS TO: DATE OF MAILING: 8/08/96 UPARC INC., R.H.A. BORROWING CORP. I ETAL ISSUED THROUGH AGENCY OR OFFICE AT: CITY OF CLEARWATER BALA CYNWYD PA EMPLOYEES & VOLUNTEERS 711 MAPLE STREET CLEARWATER FL 34615 (Applicable item marked [iJ) 0 You are hereby notified in accordance with the terms and conditions of the above mentioned policy, and in accordance with law, that your insurance will cease at and from the hour and date mentioned above, o Reason for cancellation: Nonpayment of premium 0 You are hereby notified in accordance with the terms and conditions of the above mentioned policy, and in accordance with law, that your insurance will cease at and from the hour and date mentioned above, Reason(s) for cancellation: See the "Imoortant Notices" section below for other information that may aoolv, 0 You are hereby notified in accordance with the terms and conditions of the above mentioned policy, and in accordance with law, that your insurance will cease at and from the hour and date mentioned above. Reason(s) for cancellation: You are permitted by law to appeal this cancellation. Appeal should be filed before the effective date of cancellation set forth in this Notice. Forms for such appeal and the regulations pertaining thereto may be obtained from the offices of the Department of Insurance. Appeals must be accompanied by a deposit. You or this Company may be charged with the costs of the appeal, depending on the outcome. (Appeal is not permitted in the case of cancellation for nonpayment of premium.) See the "Important Notices" section below for other information that mav aoply, 0 Gross unearned premium will be mailed to you within 15 working days after the effective date of cancellation, except 90 days in the case of audit policies, 0 Gross unearned premium will be mailed to you within 10 working days of our receipt of your audit. 0 Unearned premium will be returned to you as soon as practicable, 0 As the premium has not been paid, a bill for the premium earned to the time of cancellation will be forwarded in due course, 0 Other: !XX You are hereby notified in accordance with the terms and conditions of the above mentioned policy, and in accordance with law, thatthe above mentioned policy will expire effective at and from the hour and date mentioned above and the policy will NOT be renewed, Reason(s) for nonrenewal: POOR LOSS EXPERIENCE If this nonrenewal pertains to a policy of motor vehicle liability, personal injury protection, medical payments or collision insurance, or any combination thereof, - ---, .. and such policy is not being renewed because an operator insured under the policy was involved- in a-motorvehicle accident, Floridan law provides that you may be entitled to the renewal of your policy under the conditions cited on the reverse side of this notice under the caption "Conditions for Renewing Your Motor Vehicle Policy", If any of the conditions apply, please contact us or your agent immediately, II See the "Important Notices" section below for other information that may aooly, I CON~!NUITY OF MOTOR VEHICLE"INSURANCE: IF THIS NOTICE PERTAINS TO THE CANCELLATION OR NON RENEWAL OF MOTOR VEHICLE INSURANCE, PLEASE SEI THE IMPORTANT INFORMATION ON THE REVERSE SIDE CONCERNING THE CONTINUITY OF YOUR INSURANCE. Florida Joint Underwriting Association Information (applicable only to policies providing Automobile Liability and / Dr Personal Injury Protection coveragel' I.f the policy being cancelled or nonrenewed provides automobile liability and/or personal injury protection, you are possibly eligible for automobile insurance throug another insurer or through the Florida Joint Underwriting Association, For further information regarding replacement insurance, either from another insurer or throug the Association, please consult you agent or company representative, This notification of the availability of the Florida Joint Underwriting Association is given pu I' suant to the provisions of Section 627728 of the Florida Statutes. o Consumer Report: In compliance with the Fair Credit Reporting Act (Public Law 91-508), you are hereby informed that the action taken above is being taken wholl or partly because of information contained in a consumer report from the following consumer reporting agency: ..",-I'L'" INSURANCE COMPANY NAME AND ADDRESS OF INSURED CANCEL- LATION Premium Adjustment: NON- RENEWAL IMPORTANT NOTICES (NAME) (ADDRESS) GU 8817k (Ed, 10,89) UNIFORM PRINTING & SUPPLY, lNG, @ 1989 INSURED'S COPY a I i. --- IMPORTANT INFORMATION Concerning Your Motor Vehicle Insurance If the motor vehicle insurance policy being cancelled or nonrenewed provides personal injury protection benefits and property damage liability insurance, Florida law requires that we report such action to the Department of High- way Safety and Motor Vehicles within 45 days from the effective date of the cancellation or nonrenewal. Failure to maintain personal injury protection and property damage liability insurance on a motor vehicle when re- quired by law may result in the loss of your motor vehicle registration and driving privleges in this state, Should your re'gistration and driving privileges be suspended, the following fee will be charged for the reinstatement of your motor vehicle registration and/or driver's license (if both your registration and license are suspended, only one reinstatement fee shall be charged to reinstate the registration and license): $ ISO -first reinstatement $ 250 - second reinstatement $ 500 - each subsequent reinstatement during 3 years following the first reinstatement) If you do not have a second reinstatement within 3 years after the initial reinstatement, the reinstatement fee will be $150 for the first reinstatement after that 3 year period, Conditions for Renewing Your Motor Vehicle Policy We will renew your policy if you can demonstrate that the operator involved in the accident was: (1) Lawfully parked; (2) Reimbursed by, or on behalf of, a person responsible for the accident or has a judgement against such person; (3) Struck in the rear by another vehicle headed in the same direction and was not convicted of a moving traffic violation in connection with the accident; (4) Hit by a "hit-and-run" driver, if the accident was reported to the proper authorities within 24 hours after discovering the accident; (5) Not-conviGtedof a l1lOlfing _traffic violation in connection with the accident, but the operator of the other automobile involved in such accident was convicted of a moving traffic violation; (6) Finally adjudicated not to be liable by a court of competent jurisdiction; (7) In receipt of a traffic citation which was dismissed or nolle prossed; or (8) Not at fault, as evidenced by a written statement from the insured establishing facts demonstrating lack of fault, which are not rebutted by information in the insurer's file from which the insurer in good faith deter- mines that the insured was substantially at fault.