RETURN TO THE FHCF
FLORIDA HURRICANE CATASTROPHE FUND
EXPOSURE EXAMINATION – CONTRACT YEAR 2014
REQUIRED RECORDS CHECKLIST
Please provide us with the following information and return this checklist with the data:
Company Name:
Group Name:
Please submit only one CD (or DVD) per company with ALL of the following records:
Required Documents
Required Records Checklist
Direct Written Premium (DWP) Report for the year ending 12/31/13 *
Statutory Page 14 (Florida direct written premiums) for the year ending 12/31/13
Completed Operations Questionnaire
Attachments required for question 9 regarding single structures with mixed occupancies, if
applicable
Attachment required for question 29 regarding non-owner occupied condos, if applicable
Attachments required for questions 54 and 55 regarding Specialized Fine Arts, if applicable
Completed Construction Mapping Worksheet and copy of approved mapping, if applicable
Definition of Windstorm Mitigation Features reported to the FHCF for structure opening protection
and roof shape, for both personal and commercial lines of business. Please identify the codes for
which credits are given.
List of all forms and endorsements used (as of the Data Call date) for all covered and reported policies
including numbers and titles (Please provide in Microsoft Excel format).
Copies of all forms and endorsements included in the list referenced above.
Item to Return
CD-Rom
CD-Rom
CD-Rom
CD-Rom
CD-Rom
Included?
CD-Rom
CD-Rom
CD-Rom
CD-Rom
CD-Rom
CD-Rom
* For review purposes, policy numbers in the Data Call File and DWP File must be formatted alike. If not, an explanation on how
to match the numbers is required.
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 exposure examination as well as an executive
contact for the Company. Indicate the individual(s) that the FHCF should correspond with regarding the examination findings by
checking the box to the left of the name.
Exam Coordinator:
Name
Phone Number
Title
FAX Number
Company Name
Email Address
Address
City, State & ZIP
Executive Contact:
Name
Phone Number
Title
FAX Number
Company Name
Email Address
Address
City, State & ZIP
Revised 6/14