NOTICE OF POLICY CHANGE1
SCOTTSDALE INSURANCE COMPANY
8877 N GAINEY CENTER DR
PO BOX 4110
SCOTTSDALE AZ 85261 -4110
NOTICE OF POLICY CHANGE
Named Insured & Mailing Address: Producer: 12739
CITY OF CLEARWATER EMERGENCY
PO BOX 4748
CLEARWATER FL 33758
RISK PLACEMENT SERVICES
TWO PIERCE PL 20 FL
ITASCA IL 60143
Policy No.: XLS0084483
Type of Policy: EXCESS LIABILITY OCCURRENCE
Date of Change: 10/01/2013; 12:01 A.M. Local Time at the mailing address of the Named Insured.
This notice is to advise you of changes in this policy on the effective date shown above.
The description of the change is as follows: SEE ATTACHED NOTICE TO POLICYHOLDER
Named Insured
XLS0084483
CITY OF CLEARWATER EMERGENCY
PO BOX 4748
CLEARWATER FL 33758
FORM# CP9697FL51995
ODEN 3.0.13.04a
Copy for Named Insured
Date Mailed:
29th day of July, 2013
GARY MCAULIFFE
FLCPI2ANY REAS
07292013CNNY
Page 1 of 1
Jk. SCOTTSDALE INSURANCE COMPANY®
National Casualty Company
Scottsdale Indemnity Company
SCOTTSDALE
SURPLUS LINES INSURANCE COMPANY
NOTICE TO POLICYHOLDER
RE: CITY OF CLEARWATER EMERGENCY
POLICY # XLS0084483
We would like the opportunity to quote the renewal of your Public Entity insurance policy. Please contact
your local agent for an application.
The following changes may take place in addition to any changes that you request on your application:
RATE INCREASE:
Based on expiring exposures, the rates may increase at renewal.
WE WILL BE USING THE CX0001 ISO COMM EXCESS LIABILITY COVERAGE FORM. UPDATED EDI-
TIONS OF FORMS WILL BE USED AND ALL FORMS MUST BE COMPATIBLE WITH CX0001.
CERTIFIED ACTS OF TERRORISM COVERAGE:
You may be required to elect or reject coverage for Certified Acts of Terrorism for your policy prior to binding
coverage. An additional premium may be charged if coverage is provided.
PLEASE NOTE:
We will require complete applications and questionnaires for all lines of coverage requested to insure our
underwriting /exposure information is complete for the renewal process. The insured's signature will be re-
quired prior to binding. Please provide the following:
• PE- APP- GEN -GA (10 -10) Public Entity Applicant Information Section
• PE- APP -GL -GA (10 -04) General Liability Section
• PE- APP- UMB -GA (10 -04) Umbrella /Excess Liability
* ** *Applications, contact information and a submission checklist are found on the
Scottsdale web portal at www.scottsdaleins.com * * **
We appreciate your business and look forward to working with you on this account!
Af ?,LOR9 /i_nnN
•
i
SCOTTSDALE INSURANCE COMPANY
8877 N GAINEY CENTER DR
PO BOX 4110
SCOTTSDALE AZ 85261 -4110
NOTICE OF POLICY CHANGE
Named Insured & Mailing Address: Producer: 12739
CITY OF CLEARWATER EMERGENCY
PO BOX 4748
CLEARWATER FL 33758
RISK PLACEMENT SERVICES
TWO PIERCE PL 20 FL
ITASCA IL 60143
Policy No.: WLS0000438
Type of Policy: GENERAL LIABILITY OCCURRENCE
Date of Change: 09/02/2013; 12:01 A.M. Local Time at the mailing address of the Named Insured.
This notice is to advise you of changes in this policy on the effective date shown above.
The description of the change is as follows: SEE ATTACHED NOTICE TO POLICYHOLDER
Named Insured
WLS0000438
CITY OF CLEARWATER EMERGENCY
PO BOX 4748
CLEARWATER FL 33758
FORM# CP9697FL51995
ODEN 3.0.13.04a
Copy for Named Insured
Date Mailed:
30th day of July, 2013
FLCP15ANY REAS
07302013CNNY
Page 1 of 1
■
SCOTTSDALE INSURANCE COMPANY®
National Casualty Company
Scottsdale Indemnity Company
SCOTTSDALE
SURPLUS LINES INSURANCE COMPANY
NOTICE TO POLICYHOLDER
RE: CITY OF CLEARWATER EMERGENCY
POLICY # WLS0000438
We would like the opportunity to quote the renewal of your Public Entity insurance policy. Please contact
your local agent for an application.
The following changes may take place in addition to any changes that you request on your application:
RATE INCREASE:
Based on expiring exposures, the rates may increase at renewal.
GENERAL LIABILITY COVERAGE RESTRICTION:
Your renewal will include a Hydraulic Fracturing exclusion, GLS -341s (8 -12). This excludes claims and loss
adjustment expense associated with hydraulic fracturing.
UPDATED EDITIONS OF FORMS WILL BE USED ON THE RENEWAL POLICY.
CERTIFIED ACTS OF TERRORISM COVERAGE:
You may be required to elect or reject coverage for Certified Acts of Terrorism for your policy prior to binding
coverage. An additional premium may be charged if coverage is provided.
PLEASE NOTE:
We will require complete applications and questionnaires for all lines of coverage requested to insure our
underwriting /exposure information is complete for the renewal process. The insured's signature will be re-
quired prior to binding. Please provide the following:
• PE- APP- GEN -GA (10 -10) Public Entity Applicant Information Section
• PE- APP -GL -GA (10 -04) General Liability Section
• PE- APP- UMB -GA (10 -04) Umbrella /Excess Liability
* ** *Applications, contact information and a submission checklist are found on the
Scottsdale web portal at www.scottsdaleins.com * * **
We appreciate your business and look forward to working with you on this account!
ADM -982 (2 -06)