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PO Box 1623 ‘AMENDED
Winston Salem, NC 27102-1623
RE: Company Name: Direct General Insurance Company
Insured: ‘Yulia Lurie
Claim Number: 230773018
Policy Number: 2019146894
Date of Loss: 09/10/2023
Your Client: LeidyMazo
‘As requlrod by Florida Statute 627.4137, the folowing ls our Statement Under Oath:
Stato of Florida ) a
}ss:
County of Hillsborough )
Before me, the undersigned aulhorly personally appeared anc! after being fist sworn under oath, deposes and says:
a. Name of Insurance Company: Direct General Insurance Company
b, Name of each insured: Yolla Lurio
Limits of lability coverage: Bodily Injury $25,000 per person / $60,000 per accident
Property Damage $28,000 per accident
6. Coverage defenses:
Diroct General Insurance Company reserves the right to assert any polly or coverage
defenses that may become krown during the course ofthe investigation and handling of
this claim, Pursuant to Section 627.4137(2) Florida Statutes, this statement will be
amended upon discovery of any new facis affecting our initial disclosures.
‘¢. Copy of declarations and policy are enclosed.
Possible excess coverage for Zachary Lurie under his fether's policy with Progressive under policy number 9673007S8NA092009.
We are not aware of any othor Excess or Umbrella Policies that apaly to this loss, and nelther Direct General Insurance Company nor
any ofits subsidiary corporations/companies have written any Excess or Umbralia Poticies covering the insureds.
‘hereby aitest to the accuracy ofthe information provided above. if you feel that Dteot General Insurance Company has tailed to fully
‘comply with all of the requirements as set forth under Florida Statute 627.4137, please do not hesitate to contact myself or the assigned
adjustor atthe numbor Iistod. ee
FURTHER AFFIANT SAYETH NOT,
IN WITNESS WHEREOF, the undersignga is instrument this 27th day of Novembor, 2023.
‘Subscribed and sworn to before me, a Notary Public in and forthe State of Florida, County of
fishorough, this 27th day of November,
2028, by the above named manager, who acknowledged the same fo be box free and vo 4,
‘CARDACE. MESSLER
ry Public
[COMMISSION AHH CBTES? 5905 Hampton Oaks Phny
Novorba 30,2024 Ta
2 mpa, FL 39610
ig Pb Us My Commission expires:
