NOTICE
This insurance policy is delivered as surplus lines coverage under the Louisiana Insurance Code.
In the event of insolvency of the company issuing this contract, the policyholder or claimant is not covered by the Louisiana Insurance Guaranty Association or the Louisiana Life and Health Insurance Guaranty Association, which guarantees only specific types of policies issued by insurance companies authorized to do business in Louisiana.
This surplus lines policy has been procured by the following licensed Louisiana surplus lines broker:
Signature of Licensed Louisiana Surplus Lines Broker
or Authorized Representative
Printed Name of Licensed Louisiana Surplus Lines Broker
La. R.S. § 22:433
Former R.S. 22:433 redesignated as R.S. 22:163 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.