FLOOD INSURANCE EXPIRATION NOTICEPOLICY NUMBER: 87024150712012
NEW HAMPSHIRE INSURANCE COMPANY
FLOOD INSURANCE EXPIRATION NOTICE
IMPORTANT: THIS FLOOD INSURANCE POLICY EXPIRED: 6/23/2013
(NO FURTHER NOTICE WILL BE SENT - SEE REVERSE FOR NOTICE THAT MIGHT AFFECT THIS POLICY)
INSURED NAME & MAILING ADDRESS
.110.111111.110111111- 11.110111.11.1.11.1.10.11.11111111.0
>003110 3371752 00131 092201 10Z
CITY OF CLEARWATER
% POST# 100188 GRN# 128074
PO BOX 4748
CLEARWATER, FL 33758 -4748
PRODUCER NAME & MAILING ADDRESS
PRODUCER #:03 600 -008 89 -000 -00001
GALLAGHER, ARTHUR J & CO
DBA ARTHUR J GALLAGHER RISK MANAGEMENT SERVICES
200 S ORANGE AVE STE 1350
ORLANDO, FL 32801 -3439
(407)370 -2320
LOCATION OF INSURED PROPERTY
1 CAUSEWAY BLVD
CLEARWATER BEACH, FL 33767 -0000
I. Option 1 includes a 10% increase in
the amount of building coverage and
a 5% increase in the amount of
contents coverage
COVERAGE
DEDUCTIBLE
PREMIUM OPTIONS
BUILDING
$44,000
CONTENTS
$0
BUILDING
$5,000
CONTENTS
$0
1 $3,801.00
2. Option 2 is the amount of insurance
coverage currently in force.
..
COVERAGE
DEDUCTIBLE
PREMIUM OPTIONS
BUILDING
$40,000
CONTENTS
$0
BUILDING
$5,000
CONTENTS
$0
2 $3,462.00
For any questions regarding deductible or coverage amounts please contact your agent.
POLICY #: 87024150712012
EXPIRATION DATE: 6/23/2013
INSURED COPY - RETAIN FOR YOUR RECORDS
THIS IS NOT A BILL
If you are now responsible for the payment of this premium, please contact your
agent and change the payor status of this policy.
*If mailing address & /or property address are incorrect, PLEASE NOTIFY AGENT *
REMITTANCE ADDRESS
NEW HAMPSHIRE INSURANCE COMPANY
PO Box 2057
Kalispell, MT 59903 -2057
PAYOR NAME & MAILING ADDRESS
GALLAGHER, ARTHUR J & CO
DBA ARTHUR J GALLAGHER RISK MANAGEMENT SERVICES
200 S ORANGE AVE STE 1350
ORLANDO, FL 32801 -3439
(407)370 -2320
INSURED NAME & MAILING ADDRESS
CITY OF CLEARWATER
% POST# 100188 GRN# 128074
PO BOX 4748
CLEARWATER, FL 33758 -4748
Print Date: 6/24/2013
INFORMATION
1. The policy indicated on the reverse side expired at 12:01 A.M. on the date shown unless the renewal payment is
received by the Flood Insurance Processing Center within 30 days of the expiration date, in which case the policy will
be renewed without any lapse in coverage. If payment is not received within 30 days of the expiration date, the policy
may be renewed and a thirty -day waiting period, commencing from the date premium is received, will apply before
coverage is effective. If the renewal payment is made by certified mail to the flood processing center prior to the
expiration date, the certified mailing date will also assure renewal without any lapse of coverage.
2. To obtain a reissue of an expired policy with a revised effective date, you or your agent may mail Part B of this
notice (or your agent can mail a new application) together with the premium payment for insurance option selected
( "1" or "2" of Part A), to the flood processing center within 90 days following the expiration date of this policy. If
Part B of this or an application and premium payment are received by the flood processing center within 30 days
following the date and time of the expiration (expiration date plus 29 days), the new policy is placed in force with no
lapse of coverage. If Part B of this notice or an application and premium payment are received by the flood processing
center beyond the 30 day period but within the 90 days following the date and time of expiration (expiration plus 89
days), the policy is placed in force 30 days following receipt.
CERTIFIED MAIL — In those cases where Part B of the Expiration/Reissue Notice and the premium payment are
mailed to the flood processing center by certified mail, the certified mailing date is considered to be the date of receipt.
IF MORE THAN 90 DAYS HAVE PASSED SINCE THE POLICY EXPIRATION DATE, A NEW APPLICATION
MUST BE SUBMITTED BY THE AGENT.
3. The amounts of insurance available are shown as "Maximum Insurance Available" on the front of this form. To
increase coverage above the limits provided by Options "1" or "2 ", after mailing Part B of this form or an application
together with the premium payment, contact your agent concerning an endorsement to increase coverage.
4. If Mortgagee (or Trustee) is included as a named payee on this policy, the insurance shall continue in —force for
the benefit only of the Mortgagee (or Trustee) for 30 days after the mailing of this notice.
5. PLEASE REMEMBER: IF YOU WERE REQUIRED TO BUY THIS POLICY BECAUSE YOU RECEIVED A
DISASTER LOAN OR GRANT, YOU MUST MAINTAIN IT OR YOU MAY NOT GET FUTURE DISASTER
ASSISTANCE.