POLICY CHANGE (8)LexisNexis/FI RSt
PO Box 11563
Milwaukee, WI 53211-0563
IMPORTANT:
INSURANCE COVERAGE NOTIFICATION(S)
I IIIIII IIIA IIIA IIIA VIII VIIIVIII IIII IIIIII VIII VIII VIII IIT VIII IIIA IIIA IIII IIIIII IIII IIIIIIII II IIII
2040493-15925075-1-M 04960 11 S1 16
CITY OF CLEARWATER
600 CLEVELAND ST FL 6
CLEARWATER FL 33755-4167
'III'1Ir11uiI11IiIIiI'iIIIIIII"1111111111111111111111111111111
Total Property Notifications with this Document: 2
LexisNexis is not the Insurance Company.
Do not send premium payments to LexisNexis/FIRSt.
- For any and all policy changes you must contact the Insurance
Company, Carrier, or Producer listed in the detail below.
- For all cancellation, non -renewal, expiration, and lapse notices
- all coverage will cease at 12:01 AM local time at the premises,
unless otherwise shown in the item detail provided.
- Premium Bill and Renewal Bill items require action on the part
of the Loss Payee/Mortgagee listed.
- If you want to receive future notifications electronically, email
firstsupport@ lexisnexisrisk.com.
- This Insurance notice is sent to you as the Loss
Payee/Mortgagee/Additional Interested Party on behalf of the
carrier listed.
RECEIVED
A 022 2C
OFFICIAL REC ;r A ^'�
L GISLATIYE S:•
February 27, 2020 Notifications may print on back of page and on subsequent pages.
Policy: 32-76047920-2019 REASON: Policy Change Carrier: Philadelphia Indemnity Insurance Company
Insured: PARRISH SHANNON -708 FAIRWOOD LN-CLEARWATER-FL-33759 Pol. Type: Flood Standard
Mortgagee/Add.Party: CITY OF CLEARWATER -600 CLEVELAND ST FL 6-CLEARWATER-FL-33755-USA Eff. Dte: 12/26/2019
Insurance: Philadelphia Indemnity Insurance Company -PO Box 2057 -Kalispell -MT -59903 Pol. From: 03/05/2019 Pol. To: 03/05/2020
Producer: COMMONWEALTH INSURANCE LLC -4175 WOODLANDS PKWY -PALM HARBOR -FL -34685 727.787.8151 Total Policy Premium: 351.00
Prop. Loc: 708 FAIRWOOD LN-CLEARWATER,FL 33759 PremiumAmount: 0.00
Loan #: 0000000
Coverage ov r AmUDeduct Coverage Coverage Amt/Deduct
Dwelling 96,800/1,000 Contents 31,500/1,000 This is not an Invoice/Bill
Dwelling Replacement Cost 88,000
Flood Zone (Rated/Current): AE/ GrandFathered: N
Community: CLEARWATER, CITY OF Number: 1250960126G #UNTS: 00001 #FLRS: 2 #BLDGS: 1
Notes: Building Description: Single Family Home; This is not a bill FIRSt Id: 18058-I183-15925075-527885115
Policy: 32-76047920-2020 REASON: Policy Change Carrier: Philadelphia Indemnity Insurance Company
Insured: PARRISH SHANNON -708 FAIRWOOD LN-CLEARWATER-FL-33759 Pol. Type: Flood Standard
Mortgagee/Add.Party: CITY OF CLEARWATER -600 CLEVELAND ST FL 6-CLEARWATER-FL-33755-USA Eff. Dte: 03/05/2020
Insurance: Philadelphia Indemnity Insurance Company -PO Box 2057 -Kalispell -MT -59903 Pol. From: 03/05/2020 Pol. To: 03/05/2021
Producer: COMMONWEALTH INSURANCE LLC -4175 WOODLANDS PKWY -PALM HARBOR -FL -34685 727.787.8151 Total Policy Premium: 369.00
Prop. Loc: 708 FAIRWOOD LN-CLEARWATER,FL 33759 PremiumAmount: 0.00
Loan #: 0000000
Coverage Coverage Amt/Deduct v ra a Coverage Amt/Deduct
Dwelling 96,800/1,000 Contents 31,500/1,000 This is not an Invoice/Bill
Dwelling Replacement Cost 88,000
Flood Zone (Rated/Current): AE/ GrandFathered: N
Community: CLEARWATER, CITY OF Number: 1250960126G #UNTS: 00001 #FLRS: 2 #BLDGS: 1
Notes: Building Description: Single Family Home; This is not a bill FIRSt Id: 18058-I183-15925075-527885116
Page 1 of 1