March 9, 2017

Information Required on Contract: Sample Face Page

Per Florida Statute 626.924, every surplus lines agent through whom surplus lines coverage is procured shall write or print on the outside of the policy and on any certificate, cover note or other confirmation of the insurance the following information:

1. Name, address, and license number of the surplus lines agent;

2. Name and address of the producing agent through whom the business originated; and

3. The following text stamped or written upon the first page of the policy:

a. THIS INSURANCE IS ISSUED PURSUANT TO THE FLORIDA SURPLUS LINES LAW. PERSONS INSURED BY SURPLUS LINES CARRIERS DO NOT HAVE THE PROTECTION OF THE FLORIDA INSURANCE GUARANTY ACT TO THE EXTENT OF ANY RIGHT OF RECOVERY FOR THE OBLIGATION OF AN INSOLVENT UNLICENSED INSURER.

4. Surplus lines policies issued on or after October 1, 2009 shall have stamped or printed on the face of the policy in at least 14-point, boldface type, the following statement:

a. SURPLUS LINES INSURERS’ POLICY RATES AND FORMS ARE NOT APPROVED BY ANY FLORIDA REGULATORY AGENCY.

Per Florida Statute 626.9374, any surplus lines, personal lines residential property insurance policy issued on or after October 1, 2009, containing a separate hurricane or wind deductible must on its face include in at least 14-point, boldface type the following statement:

THIS POLICY CONTAINS A SEPARATE DEDUCTIBLE FOR HURRICANE OR WIND LOSSES, WHICH MAY RESULT IN HIGH OUT-OF-POCKET EXPENSES TO YOU.

A surplus lines, personal lines residential property insurance policy issued on or after October 1, 2009, containing a coinsurance provision must on its face include in at least 14-point, boldface type the following statement:

THIS POLICY CONTAINS A CO-PAY PROVISION THAT MAY RESULT IN HIGH OUT-OF-POCKET EXPENSES TO YOU.

Please note: The disclosures above in regards to the hurricane or wind deductible and the coinsurance provision are only required to be shown on the policy face page for personal lines residential property insurance policies.

5. Per Florida Statute 626.922 and the Agent Procedures Manual, the following information must also be included on the policy face page:

• Policy premium
• Policy fees (including inspection fees, membership fees, survey fees, etc.)
• Florida tax
• FSLSO Service Fee
• Citizen's Assessment (policies effective prior to 7/1/15)
• EMPA Surcharge
• Florida Hurricane Catastrophe Fund Assessment (policies effective prior to 1/1/15)
• Surplus lines agent’s countersignature

All required language must be shown on the policy declaration page or face page. FSLSO has a Sample Face Page on our website that can assist customers in determining how best to include all of the required information on the first page of the policy.  

The Sample Face Page includes all of the required language and information and can be used in lieu of placing this language on the actual declaration page. The Sample Face Page is not a required form, but was designed by FSLSO as an alternative means for providing the mandatory information and disclosures when there is not adequate space on the policy declaration page.