FLOOD DWELLING FORM STANDARD POLICY ENDORCEMENT DECLARATION00599 4405272 001199 002397 0002/0002
:,`cYaa7iyL, National Flood Insurance Program
FE A
U.S. Department of Homeland Security
P.O. Box 2965
Shawnee Mission, KS 66201 -1365
(800) 638 -6620
FLOOD DWELLING FORM STANDARD POLICY ENDORSEMENT DECLARATI
Policy Number
SF00670217
Named Insured and Mailing Address: RECEIVED Carin Blatt t
609 Fairwood Forest Dr
Clearwater, FL 33759 -2854 AUG 112014
OFFICIAL RECORDS AND
LEGISLATIVE SRVCS DEPT
Policy Period: 08/25/2013 12:01am to 08/25/2014
12:01am
Policy Term: One year
EFFECTIVE DATE OF CHANGE: 08/25/2013
James R Wells Insurance Agency Inc
2270 Drew St Ste A
Clearwater, FL 33765 -3344
Agent Phone: 727 - 799 -4665
Payor: 1st mortgagee
Property Location:
609 Fairwood Forest Dr
Clearwater, FL 33759 -2854
RATING DESCRIPTION
Property/Building
Contents Location
Insured's Principal Residence: Y
Two to four family; Two floors; Non - elevated without basement
III. Property Covered, Paragraph B.
Date of construction or substantial improvement was on 01/01/1984
Lowest floor only above ground level and higher floors Subject to,
LOCATION INFORMATION
Community Name: CLEARWATER, CITY OF No: 1250960010D
Status: Regular CRS Class: 7 Flood Risk/Rated Zone: AE Current Flood Zone: AE Elevation Difference: 1 Grandfathered: N
COVERAGE AND RATING INFORMATION
Coverage Type
Coverage Limit
Deductible
Rate
Deductible Discount
Premium
Building
Contents
$ 147,100 $ 1,000
00.57/00.09 $ 0.00
38/00.12 $ 0.00
ANNUAL SUBTOTAL
CRS DISCOUNT(15 %)
RESERVE FUND ASSESSMENT
FEDERAL POLICY FEE
TOTAL PREMIUM
THIS IS NOT A BILL
$ 30,500 $ 1,000 00.
$ 420.00
$ 102.00
$ 522.00
$ —78.00
$ 0.00
$ 40.00
$ 484.00
Policy Changes:
First Mortgagee Changed
Attachments:
FIRST MORTGAGEE
PLANET HOME LENDING ISAOA ATIMA
PO BOX 5023
TROY, MI 48007
LOAN NUMBER: 1000023109
SECOND MORTGAGEE
City of Clearwater ISAOA ATIMA
112 South Osceola Ave.
Clearwater, FL 33756
LOAN NUMBER: RL -1735
Issue Date: 08/04/2014
Second Mortgagee Copy
FD0001
002297(2:2):89767.1134
SECOND MORTGAGEE
>000599 4405272 0001 092201 10Z
City of Clearwater ISAOA ATIMA
112 South Osceola Ave.
Clearwater, FL 33756
DATE: 08/04/2014
00599 4405272 001198 002395 0001/0002
National Flood Insurance Program
US. Department of Homeland Security
P.O. Box 2965
Shawnee Mission, KS 66201 -1365
FEMA
002296(1:2):89767.1134