RENEWAL NOTICEIMPORTANT: Mortgagee /Additional Insured Notification
You are receiving this notice through a service called
NoticeXChange. Inside this mailing are notices for multiple
insurance carriers. Please see the instruction section for
additional information.
07/15/2013
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THE CITY OF CLEARWATER
PO Box 4748
Clearwater, FL 33758 -4748
The notification(s) below show what action (indicated in the
Reason) that was taken by the 'Carrier' shown. Please see
the Policy, Eff From, Property, or Premium Amt fields below
to obtain specific details pertaining to each notice.
Instructions:
1) For Reason: Renewal Bill please remit payment to the
company listed in the 'Payable To section, check
the 'Payment Enclosed' box, and remit the 'Amount Due'
by the 'Due Date indicated.
2) Please contact the insurance carrier or agent/producer
if you are no longer the additional insured or loss payee.
3) Contact NoticeXChange by EMAIL at
Info @NoticeXChange.com or phone at
1(800)372 -7983 to change your mailing address.
4) We welcome your suggestions regarding our form. If
you would like to receive future notifications
electronically please let us know at
Info @NoticeXChange.com.
Total Notifications With this Document: 1
Policy:
Insured:
Property:
Bldg. Desc.:
,,;Loan No
.1
Premium Amt.:
Z Carrier/
o Payable To:
Producer:
.; Mortgagee:
°a.
99- 04662655 -2013
Turner; Shandra
911 Metto St Clearwater, FL 33755
Reason:
$330.00 Incr. Prem. Amt.: $331.00
Old Dominion Insurance Company
PO Box 2057 Kalispell MT 59903 USA
Phone: 7272605520
Rebecca S Avrin Inc
31828 Us Highway 19 N Palm Harbor, FL
THE CITY OF CLEARWATER
ISAOA ATIMA
ATTN TERRY MALCOLM -SMITH
PO BOX 4748
CLEARWATER, FL 33758 -4748
Renewal Notice Lender Copy
RCV: Grandfathered: N
Coverage
Building
Increased Build
Policy
(800) 637-3846
Policy Type: Flood
34684
Coverage Amount Coverage Coverage Amount
250,000 Contents 1,400
250,000 Increased Con 1,500
Eff From: 08/28/2012 Eff To: 08/28/2013
Ded. Clause:
1,000 1,000
r-•] 1.
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