Filing at a Glance - A. M. Best

[Pages:12]SERFF Tracking #: FIMI-129367258 State Tracking #:

Company Tracking #:

State:

North Carolina

First Filing Company:

TOI/Sub-TOI:

04.0 Homeowners/04.0000 Homeowners Sub-TOI Combinations

Product Name:

Homeowners

Project Name/Number: Rebranding/

Fidelity Fire & Casualty Company, ...

Filing at a Glance

Companies:

Product Name: State: TOI: Sub-TOI: Filing Type: Date Submitted: SERFF Tr Num: SERFF Status: State Tr Num: State Status: Co Tr Num:

Effective Date Requested (New): Effective Date Requested (Renewal): Author(s): Reviewer(s): Disposition Date: Disposition Status: Effective Date (New): Effective Date (Renewal):

Fidelity Fire & Casualty Company First Protective Insurance Company Homeowners North Carolina 04.0 Homeowners 04.0000 Homeowners Sub-TOI Combinations Form 01/09/2014 FIMI-129367258 Closed-Approved

Approved

On Approval

On Approval

Jennifer Pighetti, Masha Martin Helen Best (primary) 01/09/2014 Approved 01/10/2014 01/10/2014

PDF Pipeline for SERFF Tracking Number FIMI-129367258 Generated 01/09/2014 09:45 AM

SERFF Tracking #: FIMI-129367258 State Tracking #:

Company Tracking #:

State:

North Carolina

First Filing Company:

TOI/Sub-TOI:

04.0 Homeowners/04.0000 Homeowners Sub-TOI Combinations

Product Name:

Homeowners

Project Name/Number: Rebranding/

Fidelity Fire & Casualty Company, ...

General Information

Project Name: Rebranding Project Number: Reference Organization: Reference Title: Filing Status Changed: 01/09/2014 State Status Changed: 01/09/2014 Created By: Jennifer Pighetti Corresponding Filing Tracking Number: State TOI: 04.0 Homeowners

Status of Filing in Domicile: Pending Domicile Status Comments: Reference Number: Advisory Org. Circular:

Deemer Date: Submitted By: Jennifer Pighetti

State Sub-TOI: 04.0000 Homeowners Sub-TOI Combinations

Filing Description: We are revising our Declarations Page to reflect our new logo and font revision to maintain consistency throughout our policy forms.

Company and Contact

Filing Contact Information Benjamin Treuil, Chief Financial Officer 7131 Business Park Ln Lake Mary, FL 32746

btreuil@ 407-444-5224 [Phone] 8104 [Ext]

Filing Company Information Fidelity Fire & Casualty Company 7131 Business Park Ln Suite #300 Lake Mary, FL 32746 (407) 444-5224 ext. [Phone]

CoCode: 10186 Group Code: 4773 Group Name: First Prot & Fidelity FEIN Number: 03-0549732

State of Domicile: Florida Company Type: Property & Casualty State ID Number:

First Protective Insurance Company 7131 Business Park Ln Suite #300 Lake Mary, FL 32746 (407) 444-5224 ext. [Phone]

CoCode: 10897 Group Code: 4773 Group Name: First Prot & Fidelity FEIN Number: 59-3498334

State of Domicile: Florida Company Type: Property & Casualty State ID Number:

Filing Fees

Fee Required?

No

Retaliatory?

No

Fee Explanation:

PDF Pipeline for SERFF Tracking Number FIMI-129367258 Generated 01/09/2014 09:45 AM

SERFF Tracking #:

FIMI-129367258

State Tracking #:

Company Tracking #:

State: TOI/Sub-TOI: Product Name: Project Name/Number:

North Carolina 04.0 Homeowners/04.0000 Homeowners Sub-TOI Combinations Homeowners Rebranding/

First Filing Company:

Fidelity Fire & Casualty Company, ...

Correspondence Summary

Dispositions

Status Approved

Created By Helen Best

Created On 01/09/2014

Date Submitted 01/09/2014

PDF Pipeline for SERFF Tracking Number FIMI-129367258 Generated 01/09/2014 09:45 AM

SERFF Tracking #:

FIMI-129367258

State Tracking #:

Company Tracking #:

State: TOI/Sub-TOI: Product Name: Project Name/Number:

North Carolina 04.0 Homeowners/04.0000 Homeowners Sub-TOI Combinations Homeowners Rebranding/

First Filing Company:

Fidelity Fire & Casualty Company, ...

Disposition

Disposition Date: 01/09/2014 Effective Date (New): 01/10/2014 Effective Date (Renewal): 01/10/2014 Status: Approved Comment: This references the captioned filing.

Your policy form filing is hereby approved in accordance with North Carolina General Statute 58-3-150(a). If the effective dates are changed, you must notify us in writing prior to the effective date.

Rate data does NOT apply to filing. Overall Rate Information for Multiple Company Filings Overall Percentage Rate Indicated For This Filing Overall Percentage Rate Impact For This Filing Effect of Rate Filing-Written Premium Change For This Program Effect of Rate Filing - Number of Policyholders Affected

0.000% 0.000% $0 0

Schedule Supporting Document Supporting Document Form

Schedule Item Form Filing Questionnaire FC-048 Form Revision Declarations Page

Schedule Item Status

Public Access Yes Yes Yes

PDF Pipeline for SERFF Tracking Number FIMI-129367258 Generated 01/09/2014 09:45 AM

SERFF Tracking #:

FIMI-129367258

State Tracking #:

Company Tracking #:

State: TOI/Sub-TOI: Product Name: Project Name/Number:

North Carolina 04.0 Homeowners/04.0000 Homeowners Sub-TOI Combinations Homeowners Rebranding/

First Filing Company:

Fidelity Fire & Casualty Company, ...

Form Schedule

Item No. 1

Schedule Item Status

Form Name Declarations Page

Form

Number FIM-NCHO-DEC

Edition Date 01/14

Form Type Legend:

ABE

Application/Binder/Enrollment

BND

Bond

CNR

Canc/NonRen Notice

DSC

Disclosure/Notice

ERS

Election/Rejection/Supplemental Applications

ADV CER DEC END OTH

Form Form Type Action DEC Replaced

Action Specific

Data

Previous Filing FIMI-

Number:

129228794

Replaced Form FIM-DEC-NC Number:

Readability Score

Attachments

FIM-NC-HO-DEC 01.14.pdf

Advertising Certificate Declarations/Schedule Endorsement/Amendment/Conditions Other

PDF Pipeline for SERFF Tracking Number FIMI-129367258 Generated 01/09/2014 09:45 AM

HOMEOWNERS POLICY NEW BUSINESS DECLARATIONS DATE ISSUED:

Underwritten by: PO Box 958405 Lake Mary, FL 32795

POLICY NUMBER

POLICY PERIOD

From:

To:

12:01 AM Standard Time

IF YOU HAVE QUESTIONS ABOUT YOUR POLICY, PLEASE CONTACT YOUR AGENT AT XXX-XXX-XXXX.

TO REPORT A CLAIM, CALL XXX-XXX-XXXX.

INSURED:

AGENCY:

XXX-XX-XXXXX

Telephone: LOCATION OF PROPERTY

Telephone:

COVERAGE IS PROVIDED WHERE LIMIT OF LIABILITY AND PREMIUM ARE SHOWN.

POLICY COVERAGES:

LIMIT OF LIABILITY SECTION I ? PROPERTY

A. DWELLING B. OTHER STRUCTURES C. PERSONAL PROPERTY D. LOSS OF USE

SECTION I LOSSES ARE SUBJECT TO THE FOLLOWING: DEDUCTIBLE FOR ALL PERILS: $X,XXX

[NAMED STORM DEDUCTIBLE: $XX,XXX (XX% OF COVERAGE A)] [WIND/HAIL DEDUCTIBLE: $XX,XXX (XX% OF COVERAGE A)]

SECTION II ? LIABILITY E. PERSONAL LIABILITY F. MEDICAL PAYMENTS TO OTHERS

OPTIONAL COVERAGES:

PREMIUM

POLICY CREDITS AND CHARGES

PREMIUM SUMMARY: POLICY COVERAGES:

* * * THIS IS NOT A BILL ? AN INVOICE WILL BE MAILED SEPARATELY * * *

OPTIONAL COVERAGES:

POLICY CREDITS AND CHARGES TOTAL ANNUAL PREMIUM:

FIM-NC-HO-DEC (01/14)

INSURED COPY

Page 1 of 4

Underwritten by: PO Box 958405 Lake Mary, FL 32795

HOMEOWNERS POLICY NEW BUSINESS DECLARATIONS DATE ISSUED:

POLICY NUMBER

POLICY PERIOD

From:

To:

12:01 AM Standard Time

INSURED:

AGENCY:

XXX-XX-XXXXX

Telephone: LOCATION OF PROPERTY

ADDITIONAL INTERESTS: TYPE:

ESCROW BILLED:

Telephone:

RATING INFORMATION:

FORM TYPE: TERRITORY: PROTECTIVE DEVICE CREDIT:

PROTECTION CLASS:

CONSTRUCTION TYPE:

USAGE:

YEAR BUILT:

BURGLAR ALARM

FIRE ALARM:

SPRINKLERS:

FORMS AND ENDORSEMENTS APPLICABLE TO THIS POLICY

NUMBER OF FAMILIES: OCCUPANCY:

AUTOMATIC SMOKE DETECTORS:

AUTHORIZED SIGNATURE:

DATE SIGNED:

FRONTLINE WEBSITE: FRONTLINE EMAIL: info@

FIM-NC-HO-DEC (01/14)

INSURED COPY

Page 2 of 4

Underwritten by: PO Box 958405 Lake Mary, FL 32795

HOMEOWNERS POLICY NEW BUSINESS DECLARATIONS DATE ISSUED:

POLICY NUMBER

POLICY PERIOD

From:

To:

12:01 AM Standard Time

INSURED:

AGENCY:

XXX-XX-XXXXX

Telephone: LOCATION OF PROPERTY

Telephone:

THIS POLICY CONTAINS A SEPARATE DEDUCTIBLE FOR [WIND/HAIL / NAMED STORM] LOSSES, WHICH MAY RESULT IN HIGH OUT-OF-POCKET EXPENSES TO YOU.

WARNING: THE PROPERTY INSURANCE POLICY DOES NOT PROTECT YOU AGAINST LOSSES FROM FLOODS, EARTHQUAKES, MUDSLIDES, MUDFLOR, OR LANDSLIDES. YOU SHOULD CONTACT YOUR INSURANCE COMPANY OR AGENT TO DISCUSS YOUR OPTIONS FOR OBTAINING COVERAGE FOR THESE LOSSES. THIS IS NOT A COMPLETE LISTING OF ALL OF THE CAUSES OF LOSSES NOT COVERED UNDER YOUR POLICY. YOU SHOULD READ YOUR ENTIRE POLICY TO UNDERSTAND WHAT IS COVERED AND WHAT IS NOT COVERED.

FIM-NC-HO-DEC (01/14)

INSURED COPY

Page 3 of 4

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