HomeMy WebLinkAbout2019-064A1SWORN STATEMENT IN PROOF OF LOSS
$ $25,000,000.00 Primary Laver MKLV11XP005717, 100008350405, EW0013417, D3739595A006
Amount of Policy at Time of Loss Policy Numbers
05/01/17-18
INSURANCE COMPANY ANG. Orlando, FI.
Policy Effective Dates Agency and Location
Chubb, Certain Underwriters at Lloyd's, London, Liberty International Underwriters, ACE North American and Markel /
Evanston.
By the above indicated policy of insurance you insured
Indian River County Board of County Commissioners
Against loss by:
Hurricane Damage Upon property described according to the terms and conditions of said policy
and all forms, endorsements, transfers and assignments attached thereto.
Time and Origin: A Hurricane loss occurred about O'clock on the 10th
Day of September 2017 . The cause and origin of the said loss were: Hurricane IRMA struck the Florida East
coast.
Property involved in Claim: County /Municipal
Occupancy: The building described, or containing the property described, was occupied at the time of loss as follows, and for
no other purpose whatever: County
Title and Interest: At the time of the loss the interest of your insured in the property described therein was Ownership
No other person or entity had any interest therein or encumbrance thereon, except: Not applicable
Changes: Since the above policy was issued there has been no change in title, use or possession of said property except:
None
The Total Insurance covering the described property including this policy and all other policies ( whether valid or not), binders
or agreements to insure was at the time of loss $25,000,000.00
The Replacement Cost of said property at the time of loss Not Determined
Full Cost of Repair or Replacement: Per Statement of Loss: $7,972,417.85
Applicable Depreciation: ( None
_Actual Cash Value Loss X Replacement Cost Loss $7,972,417.85
Less Deductibles/Limits; Application of the Deductibles by Scheduled Location, Un -named Locations
And the Property in the Open applied in the supporting spread sheets (-4,537,235.33)
_Actual Cash Value Claim X Replacement Cost Claim $3,435,182.52
Less amount of paid claim for Unnamed Miscellaneous Locations (-2,500,000.00)
Net Remaining Paid Claim $935,182.52
Supplemental Claim, to be filled in accordance with the terms and conditions of the
Replacement Cost coverage within N/A days from date of loss will not exceed NA
This loss did not originate by any act, design or procurement of the insured, or this subscriber; nothing has been done by or with the privity or consent
of the insured or this subscriber to violate the conditions of the policy; no articles are mentioned herein or in annexed schedules but such as were in
the building damaged or destroy, belonging to and in possession of the insured at the time of loss; no property saved has been concealed and no
attempt to deceive the company has been made. Any other information that may be required will be furnished and considered a part of this proof.
State of: Florida
Insured: INDIAN RIVER COU •ARD OF CO
MMISSIONERS
County of: INDIAN RIVER BY:
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