PURPOSE: The purpose of this amendment is to provide contact information to insureds who receive a notice of cancellation, nonrenewal, reduction in amount, or adverse modification.
EXHIBIT A
COMPANY LETTERHEAD
Policy Number(s)___________________________________________________
Expiration Date___________________________________________________
Insured Premises Location___________________________________________________
(Insurer Name)
(Toll-Free Number, if available)
(Telephone Number)
This is our office notice that the coverages afforded by the above-numbered policies will be -
[] Cancelled
[] Not Renewed
[] Reduced in Amount
[] Adversely Modified as Follows:
EFFECTIVE: 12:01 A.M. ON THE _____ DAY OF _________________,
_______________________________________________________
SPECIFIC REASON FOR TAKING ACTION SHOWN ABOVE:
_______________________________________________________
_______________________________________________________
_______________________________________________________
If you wish to secure coverages from another insurance carrier, contact your insurance producer immediately.
(Producer's Name)
(Address)
(City, State, Zip)
(Telephone Number)
You may also contact any insurance producer. If you are unable to buy coverage through the standard insurance market, an insurance producer may also apply to the Missouri Property Insurance Placement Facility for insurance coverages. Application may be made by mail, online, or in person to the following address:
MISSOURI PROPERTY INSURANCE PLACEMENT FACILITY
11116 S. Towne Square, #303, St. Louis MO 63123
Phone: (314) 421-0170
Website: missourifairplan.com
Any excess premium must be refunded within thirty (30) days.
Yours truly,
cc: Insurance Producer
cc: Mortgagee
20 CSR 500-1.100
*Original authority: 374.045, RSMo 1967, amended 1993, 1995; 379.150, RSMo 1939; 379.160, RSMo 1939, amended 1957, 1963; and 379.840, RSMo 1969.