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FEDERATED NATIONAL INSURANCE COMPANY 21ST CENTURY I PO BOX 4071931 FORT LAUDERDALE, FL 33340 1 Office: (954) 308-]4141 Fax: (954) 733-70711 Toll Free: (888) 440-68761 Send To: CITY OF CLEARWATER ISAOA, A TIMA PO BOX 4748 CLEARWATER, FL 33758 ..:.:....-----..--.--,---.-.....-.-..---- Document(s) Attached: (1) - Issuance - Dec Sheet Document Information Notice Please review the attached information on each policy to ensure that it is accurate ,,)'1 1,'1 , I, / . / ;~1 /;:1: rrl~"-' "'--.___ 't.--.~,... '_.. '.,1 .FJ n,? -::-_._ I,'i (S' ~ "'"','--', ---c.:, I ( / \" 1 -~ ,..,i) MAY_ ]"1 3 ~' FEDERATED NATIONAL INSURANCE COMPANY P.O. Box 407193 Ft. Lauderdale, FL 33340 Declaration Effective 04/17/2006 ~ Federated National Insurance COMPANY OVERNIGHT PACKAGES 3661 West Oakland Park Blvd, Suite 300 Lauderdale Lakes, FL 33311 Claims: 1-800-420-7075 P.O. Box 407193 OFt. Lauderdale, Florida 33340 Service: Contact your Agent Listed Below Name and Address of Insured BIBI CHINTAN 1131 HARRIS LN CLEARWATER, FL 33756 Name and Address of Agent INSURANCE BUREAU, INC PO BOX 31087 TAMPA, FL 33931 (800) 891-4222 Basic Coverages Premium Attached Endorsements Premium Premium Summary Assessments / Surcharges MGA Fees $902 $-60 18.00 $27 Total Policy Premium (Including Assessments & ~urcharges) $887 Location 101 Form Const Masonry County Year Town / Row House Num Fam Occup o Prot Class Terr HO-3 2003 N 03 081 BCEG 3 Pinellas Dwelling Replacement Cost Y Home Updated Protective Device Credits: Burglar Fire Sprinkler Shutter Wind / Hail Exclusion No N N N N N Coverage is provided where premium and limit of Liability is shown. COVERAGES - SECTION I LIMITS PREMIUMS Coverage -A- Dwelling $ 97,000 884.00 .......................................................................................................................................................... Coverage -B- Other Structures $ 9,700 INCL ......................................................................................................................................................... Coverage -C- Personal Property $ 48,500 INCL ................................................................................................................................................................................... Coverage -D- Loss of Use $ 19,400 INCL ......................................................................................................................................................................................................... Premium Charged for Hurricane Exposure (Shown Separately per Florida Law) 423.00 Section 1 coverages subject to $1000.00 non-hurricane deductible per loss. Section 1 coverages subject to $1940 (2%) hurricane deductible per loss. This policy contains a separate deductible for hurricane losses, which may result in high out of pocket expenses to you. COVERAGES - SECTION II Coverage -E- Personal Liability $ 300,000 18.00 ................................................................................................................................................................... Coverage -F- Medical Liability $ 1,000 INCL LOCATION OF PROPERTY INSURED 1131 HARRIS LN CLEARWATER FL 33756 Flood coverage is not provided by Federated National Insurance Company and is not part of this policy. COUNTERSIGNED: ;}....:...l ~ FNIC HO 9(10/05) Page 1 of 3 FEDERATED NATIONAL INSURANCE COMPANY P.O. Box 407193 Ft. Lauderdale, FL 33340 Declaration Effective 04/17/2006 ~ Federated National Insurance COMPANY OVERNIGHT PACKAGES 3661 West Oakland Park Blvd, Suite 300 Lauderdale Lakes, FL 33311 Claims: 1-800-420-7075 P.O. Box 407193 0 Ft. Lauderdale, Florida 33340 Service: Contact your Agent Listed Below Mortgagee I Additional Interest 01 US BANK, NA ISAOA C/O US BANK HOME MORTGAGE PO BOX 7298 SPRINGFIELD, OH45501 Agent Name and Address INSURANCE BUREAU, INC PO BOX 31087 TAMPA, Fl 33931 (800) 891-4222 Addi~lori<.l!lntGrl;'.st ~,__r.--,:~ , " Mortgagee / Additional Interest 01 . US BANK, NA ISAOA C/O US BANK HOME MORTGAGE PO BOX 7298 SPRINGFIELD, OH. 45501 Loan # 9900147061 Mortgagee / Additional Interest 02 CITY OF CLEARWATER ISAOA, ATIMA PO BOX 4748 CLEARWATER, FL. 33758 Loan # Policy Forms and Endorsements Applicable to this Policy NUMBER LIMITS HO 00 03 04 91 H001 090999 H004130998 HO 04 32 05 02 HO 04 90 04 91 HO 04 96 04 91 HO 23 70 06 97 FNIC HO 03 (02/00) FNIC HO 04 (02/00) FNIC HO 05 (02/00) FNIC HO 06 (02/00) FNIC HO 07 (02/00) FNIC HO 08 (02/00) FNIC HO 10 (02/00) FNIC HO 11 (02/00) FNIC HO 12 (02/00) FNIC HO 13 (02/00) FNIC HO 15 (02/00) FNIC HO 24 (01/06) OIR-B1-1655 (10/01/2005) FNIC HO 14 (02/00) HO 04 32 05 02 HO 04 90 04 91 DESCRIPTION PREMIUMS Homeowners 3 Special Fonn Special Provisions - Florida Sections I and II Exclusions for Computer-Related Damage or Injury Limited Fungi, Wet or Dry Rot, or Bacteria Coverage Personal Property Replacement Cost No Section II-Liability Coverages for Home Day Care Business Windstorm Exterior Paint or Waterproofing Exclusion - Seacoast - Florida Policy Jacket Florida Disclosure Notice Important Notice Form Homeowners Outline of Coverage Existing Damage Exclusion Standard Policy Coverage Important Notice to Policy Holder - Hurricane Deductible Coverage Limitation Endorsement Ordinance or Law Coverage Non Structural Hail Loss Limitation Loss Assessment Coverage Hurricane Deductible Options Notice Premium Discounts for Hurricane Loss Mitigation BuildinQ Code Compliance GradinQ Select Home Discount DwellinQ AQe CrediVSurcharQe Electronic Equipment FunQi, Wet or Dry Rot, or Bacteria Personal Property Replacement Cost Policv Fee (Fullv Earned) Citizens Assessment Recoupment Surchar!1e EmerQencv ManaQement Preparedness And Assistant Trust Fund 25% $ 2,000 $ 10,000 -42.00 -63.00 -88.00 INCL INCL 133.00 25.00 18.00 2.00 This replaces all previously issued policy declarations, if any and is subject to all forms and endorsements attached to this policy. FNIC HO 9(10/05) Page 2 of 3 Policy Number: FNC061399-04 Policy Period: 04/17/06 to 04/17/07 FLOOD COVERAGE IS NOT PROVIDED IN 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. FNIC HO 9(10/05) Page 3 of 3 -- 21 st Century Holding Company Consumer Privacy Policy This Privacy Policy is provided by 21st Century Holding Company and its subsidiaries, Assurance Managing General Agents, Inc., Federated National Insurance Company, Federated Premium Finance, Inc., American Vehicle Insurance Company, and Superior Adjusting, Inc., (hereinafter collectively, "21 st Century") The trust of our customers is 21 st Century's most valuable asset. 21 st Century safeguards that trust by keeping non-public personal information about customers in a secure environment and using that information in accordance with this Privacy Policy. This Privacy Policy includes examples of the types of non-public personal information we collect. These examples are illustrative and should not be considered a complete inventory of our information collection, use and sharing practices. In addition, you may have other privacy protections under some state laws. 21 st Century will comply with applicable state laws regarding information about you. For example, certain state laws may restrict the types of information we may disclose about you or require us to provide you with additional notices. Please note that this Privacy Policy will not apply to your relationships with other financial service providers, such as banks, credit card issuers, finance companies and independent insurance agents that are not part of the companies listed at the beginning of the Privacy Policy. Their privacy policies will govern how they collect, use and disclose personal information that you allow them to access. Below is 21 sl Century's privacy pledge tOQurcu~tomers: Information We May Collect 21 st Century may collect non-public personal information about you from the following sources: . Information we receive from you (or is provided to us on your behalf) and other firms on applications, such as your name, address, telephone number, employer, income, social security number, and date of birth; . Information about your transactions with 21 st Century or other nonaffiliated parties, such as your name, address, telephone number, age, credit card usage, insurance coverage, transaction history, claims history and premiums; . Information from consumer reporting agencies, public records and data collection agencies, such as your obligations with others and your creditworthiness; and . Information you provide to us on applications or from health care providers, such as doctors and hospitals, (to determine your past or present health condition). Health information will be collected as we deem appropriate to determine eligibility for coverage, to process claims, to prevent fraud, and as authorized by you, or as otherwise permitted or required by law. 21st Century does not distribute or sell any information about current or existing customers. The non-public personal information 21 st Century collects is used to provide customer service and administer your account. 21st Century does not distribute or sell any information about current or existing customers. . Disclosures Permitted by Law 21 st Century may disclose all of the non-public personal information described above, as permitted by law. For example, we may use affiliated and nonaffiliated parties to perform services for us, such as providing customer assistance, handling claims protecting against fraud and maintaining software for us. 21st Century also may disclose information in response to requests from law enforcement agencies, regulatory authorities, or the request of any court or government agency with proper jurisdiction. Information regarding Former Customers 21 st Century does not disclose non-public personal information about former customers or customers with inactive accounts, except in accordance with this Privacy Policy. Our Security Procedures 21 st Century restricts access to non-public personal information about you to those employees whom we determine have a legitimate business purpose to access such information in connection with the provision of products or services to you. 21 st Century employs security techniques designed to protect our customer data. Changes to this Privacy Policy 21st Century reserves the right to modify or supplement this Privacy Policy at any time. 21st Century will provide current customers with a revised notice that describes our new practices.21 st Century values its relationship with you and appreciates the opportunity to bring you quality products and services. Rev: 07/2005 POLICY NUMBER: POLICY PERIOD: to IMPORTANT NOTICE REGARDING YOUR INSURANCE COVERAGE ORDINANCE OR LAW COVERAGE OPTION TO INCREASE COVERAGE Ordinance or Law coverage provides payment for increased costs incurred by you to repair damage to or replace the insured dwelling due to enforcement of any ordinance or law regulating the construction, repair, or demolition of buildings or other structures. Your policy automatically includes Ordinance or Law coverage up to 25% of the amount for which the dwelling is insured (Coverage A). You have the option to increase your 25% Ordinance or Law coverage limit to 50% of the Coverage A limit of liability displayed on your declarations page; this selectionwilltesult in an increase in thepremiumcha..rged for the policy. If you choose to increase your 25% limit to 50%, sign and date the selection notice below and mail this entire notice to us. In order to make this change to your Ordinance or Law coverage, the signed and dated selection notice is required; verbal changes will not be accepted. If you do not elect to increase your coverage, your Ordinance or Law coverage will continue to be limited to 25% of the Coverage A limit of liability (amount already included in your policy). SELECT INCREASED LIMIT BELOW Optional 50% Limit for Ordinance or Law Coverage: I elect to have my Ordinance or Law limit increased to 50%. By selecting this limit, I reject the lower limit of25%. Signature of Named Insured Date Signed Return to: Federated NatioF'lallnsurance Company P.O. Box 407193 Ft. Lauderdale, FL 33340 FNIC - FLORIDA HO 23 (10/05) Policy#: FNC061399-04 IMPORTANT NOTICE REGARDING YOUR INSURANCE COVERAGE HURRICANE DEDUCTIBLE OPTIONS NOTICE This important notice is to infonnyou of additional Hurricane Deductibles for which you may be eligible under your Policy. FedeiatedNational Insutallceoffers Hurricane Deductibles in the amount of $500, 2%, 5% and 10%. Your current Hurricane Deductible is shown on your Policy Declarations renewal offer. If you would like to select a Hurricane Deductible other than the one reflected on your renewal offer, please contact your Agent for details and eligibility. FNIC H024 (01/06) Premium Discounts for Hurricane Loss Mitigation Company Name: Line of Business: Program Name: Policy Type: Federated National Insurance Company Homeowners Homeowners H03, H04, H06 The risk of loss from a hurricane is something that each Floridian faces. We know that hurricanes cannot be prevented, but many Floridians are not aware there are things they can do to better protect their property from damage or destruction. Certain construction techniques and features are very effective in protecting your property. If your property has these unique characteristics, you may qualify for a discount on your property insurance premiums. What are the some of the construction techniques and features? There are many different construction techniques and features. SOIne of the most commonge1"1€rally- fall _ into one of the categories listed in below. 2001 Florida Building Code Compliance (FBC) Homes built in compliance with the 2001 Florida Building Code receive a significant discount as a result of the features required by the Up to 26% new code. How do I get this discount: Contact your agent Roof Shape Hip Roof - A roof that is sloped on all four sides like a pyramid. Up to 26% Other roof shapes Up to 22% How do I get this discount? Contact your agent Opening Protection Shutters Up to 26% Special/Impact Resistant glass Up to 20% How do I get this discount: Contact your agent Roof Deck Attachment 6d nails or screws 8d nails or screws Up to 26% Dimensional lumber How do I get this discount: Contact your agent Roof Covering Asphalt shingles Wood shingles Clay or concrete tiles Up to 26% Metal panels Other roof covering How do I get this discount: Contact your agent Roofto Wall Connectors Clips Single or Double Wraps Toe Nails/Screws Up to 26% Structurally Connected Other roof to wall connectors How do I get this discount: Contact your agent Calculating Your Discount There are several important facts that you must understand prior to estimating any discounts to which you may be entitled. They are as follows: First, the discounts for the construction techniques and features listed above are not cumulative. In other words, you simply cannot add up the above items to arrive at your discount. These construction techniques and features work together and your total discount is a function of all the property's features; Second, as noted above, some of these construction techniques and features require independent certification from a licensed expert; Finally, your policy premiums are generally separated into two parts, the "wind" portion and the "non-wind" portion. Any applicable discounts are applied only against the "wind" portion of your premIUm. Now tb.at~weunde..staBd~a~ijttleDlore~l>9.1lt the_~pplication of the discounts, lets look at some examples. All of the examples below are for a residential struCture. The policy premiutnis~assumed to be $1,000 prior to any discounts; the "wind" portion is $600 and the "non-wind" portion is $400. Example #1 Construction techniques and features for a home constructed in 2003 located in an inland county: . Complies with the minimum requirements of the 2001 Florida Building Code . No Shutters . No Hip Roof Shape Applicable discount based on the techniques and features discount is 11 % Policy Premium $1000 Less (discount of 11 % X "wind" premium = (S@ New Policy Premium after discounts $934 Example #2 Construction techniques and features for a home constructed in 2003 located in an inland county: . Complies with the minimum requirements of the 2001 Florida Building Code . Shutters . Hip Roof Shape Applicable discount based on the techniques and features discount is 26% Policy Premium $1000 Less (discount of 26% X "wind" premium = ($156) New Policy Premium after discounts $844 OIR-Bl-1655 (10/0112005) Example #3 Construction techniques and features for a home constructed in 1999 located in an inland county: . Asphalt shingles connected with 6d nails . No Shutters . No Hip Roof Shape Applicable discount based on the techniques and features discount is 3% Policy Premium $1000 Less (discount of3% X "wind" premium = i.$..lID New Policy Premium after discounts $982 Example #4 Construction techniques and features for a home constructed in 1999 located in an inland county: . Asphalt shingles connected with 6d nails -.Shutters . Hip Roof Shape Applicable discount based on the techniques and features discount is 4% Policy Premium $1000 Less (discount of 4% X "wind" premium of$600.) ($W New Policy Premium after discounts $976 Summary These examples represent only a few of the many possible combinations of construction techniques and features that exist. There may additional construction techniques and features that are not listed on this form because they are not common in residential construction. If you have further questions about the construction techniques and features herein or other construction techniques and features that could result in a discount, please contact your agent. OIR-Bl-1655 (10/0112005)