HOMEOWNERS HO-3 FORM POLICY - NEW DECLARATIONSTHE JIM HORDEN AGENCY
Gayle Cindy Horden
10225 Ulmerton Rd #95
Largo, FL 33771
543
CITY OF CLEARWATER ISAOA ATIMA
PO BOX 4748
CLEARWATER, FL 33758-4748
Loan Number: Not Provided
Second Mortgagee Copy
Policy Number: FRJH4828635-01-0000
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DEC 11 2009
OFFICIAL RECORDS AND
Second Mortgagee COPY MID: 450 / AID: 450 / FID: 1 Processed Date: 1210712009
Citizens Property Insurance Corporation H03DEC0108
Citizens Service Center
CITIZENS 6678 Corporate Center Parkway
rr -.kni?scernckVORPORAPEaa Jacksonville, FL 32218-0973
Homeowners HO-3 Special Form Policy - New Declarations
Policy Number: FRJH4828635-01-0000 Policy Period: From 11/20/09 To 11120110
12:01 A.M. Eastern time at the location of the Residence Premises
Named Insured and Mailing Address:
MELANIE TABBERT
1510 Bonair St
Clearwater, FL 33755-3501
Location of Residence Premises:
1510 BONAIR ST
CLEARWATER, FL 33755
Agent: Phone (727) 581-4117
THE JIM HORDEN AGENCY -
Gayle Cindy Horden
10225 Ulmertan Rd #9B
Largo, FL 33771
FL License: A123082 Citizens ID: 000690
Coverage Is only provided where a premium and a limit of liability Is shown.
DEDUCTIBLES: ALL OTHER PERILS: $1,000 SINKHOLE:$1,000 HURRICANE DEDUCTIBLE: $1,934 (2%)
SECTION I - PROPERTY COVERAGES LIMIT OF LIABILITY ANNUAL PREMIUM
A - Dwelling $96,893 $944
B - Other Structures $9,669 INCLUDED
C- Personal Property $48,347 INCLUDED
D - Loss of Use $9,669 INCLUDED
Ordinance or Law Limit (25% of Cov. A) (see policy) INCLUDED
SECTION II - LIABILITY COVERAGES
E - Personal Liability $100,000 INCLUDED
F - Medical Payments $2,000 INCLUDED
OPTIONAL COVERAGES
Fungi (Mold) Increased Limit, Property $50,000 $72
Sinkhole Lose Coverage (see policy) INCLUDED
MANDATORY ADDITIONAL CHARGES
2007 Florida Insurance Guaranty Association Regular Assessment
Emergency Manag_emenR_PropareAnwsa"d Assistance Trust Fund .. .
2005 Citizens Market Equalization Sircharge
2005 Florida Hurricane CatastropheFund Emergency Assessment
2005 Citizens Emergency Assessment
Tax Exempt Surcharge
TOTAL POLICY PREMIUM INCLUDING ASSESSMENTS AND ALL SURCHARGES
Insured Note: The portion of your premium for Hurricane Coverage Is: $425
$14
$0
$10
$14
$18
$1,074
First Mortgagee: Second Mortgagee:
Loan Number: 0083730150 CITY OF CLEARWATER ISAOA ATIMA
FREEDOM MORTGAGE CORP CO LOAN PO BOX 4748
CARE ISAOA ATI CLEARWATER, FL 33758-4748
PO BOX 202049
FLORENCE, SC 29502-2049
Second Mortgagee Copy Page 1 of 3 MID: 450 /AID: 460 / FID: 1 Processed Date: 12/0712009
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Policy (dumber: FRJH4828635-01-0000
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Forms and Endorsements applicable to this policy:
CIT HO-3 07 08- CIT 03 33 07 04• CIT 23 94 07 08'
H03DEC 01 09
Policy Period: From 11120109 To 11120110
12:01 A M. Eastern time at the location of the Residence Premises
CIT 24 07 08• HO 04 96 04 91-
E-" iED
K CC DEC 112009
OFFICIAL RECORDS AND
LEGISLATIVE SRVCS DEPT
Form Year Built / Town/Row Construction Wind / Hall Mun Code
Type Verified House Type BCEGS Territory Exclusion Fire / Police
H03 19551Yes No Masonry 99 081 No 251 / 251
No. Of ro c on Dist To Qlat To Fire
County Occupancy Use Families Class Hydrant Station
PINELLAS Owner Primary 1 03 500 feet 2 miles
Protective Device Credits No Dec Or Prior
Burglar Insurance Seasonal Updates Age of Home
Alarm Fire Alarm Sprinkler Surcharge Surcharge Surcharge Surcharge/Credit
No No No No No WA Yes-Surcharge
Terrain / WBOR Building Type Roof Cover Roof Dock Attachment Roof-Wall Connection
B / IN 1-4 Units Non FBC Equivalent C - 8d @ 6- /0' Toe Nails
Secondary Water Roof Shaps Opening Protection FBC Wind Speed FBC Wind Design
Resistance
No Hip None WA WA
A premium adjustment of 4239 Is Included to reflect the building's wind loss mitigation features or construction techniques tnat exists.
Credits range from 0% to 67%
A premium adjustment of $0 Is Included to railkWillsa building code grade for your area. Adjustments range from a 5% surcharge to
a 46% credit.
Authorized By: Gayle Cindy Horden
Second Mortgagee Copy Page 2 of 3 MID: 450 1 AID: 450 / FID: 1 Processed Date: 12113712009
H03DEC 01 09
Policy Number: FRJH4828635-01-0000 Policy Period• From 11120109 To 11/20/10
12.01 A M. Easlam time at the location of the Residence Premises
PAGE 3
FLOOD COVERAGE IS NOT PROVIDED BY THIS POLICY
THIS POLICY CONTAINS A SEPARATE DEDUCTIBLE FOR
HURRICANE LOSSES, WHICH MAY RESULT IN HIGH
OUT-OF-POCKET EXPENSES TO YOU.
LAW AND ORDINANCE COVERAGE IS AN IMPORTANT
COVERAGE THAT YOU MAY WISH TO PURCHASE. YOU
MAY ALSO NEED-TO CONSIDER THE PURCHASE OF
FLOOD INSURANCE FROM THE NATIONAL FLOOD
INSURANCE PROGRAM. WITHOUT THIS COVERAGE YOU
MAY HAVE UNCOVERED LOSSES. PLEASE DISCUSS
THESE COVERAGES WITH YOUR INSURANCE AGENT.
INFORMATION ABOUT YOUR POLICY MAY BE MADE AVAILABLE TO INSURANCE COMPANIES AND/OR AGENTS
TO ASSIST THEM IN FINDING OTHER AVAILABLE INSURANCE MARKETS.
PLEASE CONTACT YOUR AGENT IF THERE ARE ANY QUESTIONS PERTAINING TO YOUR POLICY. IF YOU ARE UNABLE TO
CONTACT YOUR AGENT, YOU MAY REACH CITIZENS AT (669) 665-1555.
Second Mortgages Copy Page 3 of 3 MID: 450 / AID: 450 1 FID: 1 Processed Date: 12107/2009
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