<<AI List>>



Re Insured: <<Cli_BusName>>


<<Cli_First>> <<Cli_Last>>


<<Cli_City>>, <<Cli_State>> <<Cli_Zip>>



Insurance Company: <<Pol_Company:PC>> Policy Number: <<Pol_PolNum>>

Expected Policy Expiration: <<Pol_ExpireDate>>


This is not a legal notice, rather a reminder to obtain a current copy of the renewal certificate of insurance and/or policy. As with any certificate, the certificate holder should confirm with the issuing agency as to its authenticity. See the certificate and policy for additional information regarding coverage and limitations.


Issuance of a false certificate is insurance fraud and may result in legal actions by any insurance company listed on the certificate and the Special Investigative Unit of the Department of Insurance subject to fines and/or jail. It is up to you to protect your insurable interest.


<<User Name>>
<<Agncy_Address>>, <<Agncy_City>>, <<Agncy_State>>  <<Agncy_Zip>>
Phone:<<Agncy_Phone>>  |  Fax: <<Agncy_Fax>>