REQUIRED RECORDS CHECKLIST
RETURN TO FHCF
FLORIDA HURRICANE CATASTROPHE FUND
LOSS REIMBURSEMENT EXAMINATION
CONTRACT YEAR 2004
Company Name:
Group Name:
Required Document
1) Required Records Checklist
2) Completed Claims Operations Questionnaire
3) Claims Process Memo
4) Detailed Claims Listing(s)
5) IBNR documentation that supports the amount
reported in the Proof of Loss Report(s)
6) Multi-State Policy Listing – Commercial Only
7) Multi-Risk Policy Listing – Commercial Only
8) Single Structures Listing
Item to Return
CD-ROM
CD-ROM
CD-ROM
CD-ROM
CD-ROM
Included
*
*
*
*
*
CD-ROM
CD-ROM
CD-ROM
*
*
*
Be sure each CD-ROM is labeled with the Company name, hurricane and file name.
Street Address where the examination should be conducted (the FHCF examiner will only travel
to one location to conduct the examination):
Street Address
City
State
ZIP Code
Please provide the name & contact information of the person who will be coordinating the
examination, a person who is familiar with the Company’s claims systems, an actuarial contact
and an executive contact for the Company.
Exam Coordinator:
Name
Phone Number
Title
FAX Number
Company Name
Email Address
Address
City, State & ZIP
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REQUIRED RECORDS CHECKLIST
RETURN TO FHCF
Executive Contact:
Name
Phone Number
Title
FAX Number
Company Name
Email Address
Address
City, State & ZIP
Claims Contact:
Name
Phone Number
Title
FAX Number
Company Name
Email Address
Address
City, State & ZIP
Actuarial Contact:
Name
Phone Number
Title
FAX Number
Company Name
Email Address
Address
City, State & ZIP
Page 2 of 2