Certificate of true and accurate rate filing




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CERTIFICATE OF TRUE AND ACCURATE RATE FILING

I, ____________________________, _________________________________

(Print or type name) (Print or type title)
Section 627.062(9) requires that this form must be signed by either the Chief Executive Officer

or Chief Financial Officer, as well as the Chief Actuary.

and
_____________________________Chief Actuary*,

(Print or type name)
pursuant to Section 627.062(9), Florida Statutes, under oath, do swear and attest, based upon the signing officer's and actuary's knowledge, under penalty of perjury, that:
1. We have reviewed the foregoing rate filing;
2. The rate filing does not contain any untrue statement of a material fact, or omit to state a material fact necessary in order to make the statements made, in light of the circumstances under which such statements were made, not misleading;
3. The information contained in the rate filing relating to the factors described in s. 627.062(2)(b), F.S., including, but not limited to, investment income, fairly represents in all material respects the basis of the rate filing for the periods presented in the filing; and
4. The filing reflects all premium savings that are reasonably expected to result from legislative enactments and are in accordance with generally accepted and reasonable actuarial techniques.
_____________________________ or ____________________________

(Signature) Chief Executive Officer (Signature) Chief Financial Officer


_____________________________ ____________________________

(Print Name) (Print Name)

_____________________________

(Signature) Chief Actuary


_____________________________

(Print Name)


* Chief Actuary means an actuary, as defined in Section 627.0645(8), Florida Statutes, that is either employed by the insurer as the Chief Actuary or, if the insurer does not employ a Chief Actuary, is the primary consulting actuary involved in the preparation and review of this rate filing.

Notarization of Officer (CEO or CFO):

STATE OF _____________________


COUNTY OF______________________

Sworn to (or affirmed) and subscribed before me this _____day of ________, 20__, by _

__________________________________________.

Personally Known________ OR Produced Identification________________


Type of Identification Produced____________________________________

Notary Signature _____________________________


My commission expires: ___________

Notarization of Chief Actuary

STATE OF ­___________________


COUNTY OF______________________

Sworn to (or affirmed) and subscribed before me this _____day of _____, 20­­__, by

_______________________________________________.

Personally Known________ OR Produced Identification________________


Type of Identification Produced____________________________________
Notary Signature _____________________________
My commission expires: ___________


OIR-B1-1790 (03/2007) Rule 69O-170.0155


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