INSURANCEFEDERATED NATIONAL INSURANCE COMPANY
14050 NW 14th Street, Suite 180
Sunrise, FL 33323
Claims: 1- 800 - 293 -2532
Service: Contact Your Agent Listed Below
DECLARATION EFFECTIVE
11/20/2015
FEDERATED l NATIONAL
Policy Number
FE- 0000517555 -02
Policy Period 12:01 AM Eastern Standard Time
FROM 11/20/2015 TO 11/20/2016
Agent Code
04024
Named Insured and Mailing Address:
Patty Sadiku
Location of Residence Premises:
2559 Hidden Cove Ln
Agent:
COMMUNITY INSURANCE GROUP, INC.
2559 Hidden Cove Ln
505 WESTBROOK AVE
Clearwater, FL. 33763
Clearwater, FL. 33763
BRANDON, FL. 33511
Phone: (813) 685 -8040
Coverage is only provided where a premium and a limit of liability is shown.
ALL OTHER PERILS DEDUCTIBLE: $1,000
SINKHOLE LOSS DEDUCTIBLE : N/A
SECTION I — PROPERTY COVERAGES
A - Dwelling
B - Other Structures
C - Personal Property
D - Loss of Use
HURRICANE DEDUCTIBLE: (2 %) /$3,000
LIMIT OF LIABILITY
$150,000
$1,500
$75,000
$30,000
SECTION II — LIABILITY COVERAGES
E — Personal Liability $300,000
F — Medical Payments $1,000
OPTIONAL COVERAGES
Ordinance or Law Coverage
Personal Property Replacement Cost
Dwelling Age Credit/Surcharge
Claim Free Discount
Building Code Compliance Grading
Windstorm Protective Devices
Loss Assessment
Limited Fungi, Wet or Dry Rot, or Bacteria (Property)
Limited Fungi, Wet or Dry Rot, or Bacteria (Liability)
FNIC HO 9 (08 14)
ANNUAL PREMIUM
$1579.00
INCL
INCL
INCL
$ 15.00
INCL
25% INCL
$ 236.85
$- 95.01
$- 21.64
$- 127.51
$- 940.00
$1,000 INCL
$10,000 INCL
$50,000 INCL
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062854 -01 -00725
COMMUNITY INSURANCE GROUP, INC.
505 WESTBROOK AVE
BRANDON, FL. 33511
Send To: CITY OF CLEARWATER
ISAOA / ATIMA
112 S OSCEOLA AVE
CLEARWATER, FL. 33756
Additional Insured Document(s) Attached:
Policy Declarations
Document Information Notice
Thank you for selecting us as your insurance carrier. This packet contains information about your insurance policy.
• Please review all information in this packet to ensure that the policy information is accurate.
062854 -01 -00727
FEDERATED NATIONAL INSURANCE COMPANY
14050 NW 14th Street, Suite 180
Sunrise, FL 33323
Claims: 1- 800 - 293 -2532
Service: Contact Your Agent Listed Below
DECLARATION EFFECTIVE
11/20/2015
FEDERATED NATIONAL
Policy Number
FE- 0000517555 -02
Policy Period 12:01 AM Eastern Standard Time
FROM 11/20/2015 TO 11/20/2016
Agent Code
04024
MANDATORY ADDITIONAL CHARGES
Policy Fee (Fully Earned)
Emergency Management Preparedness and Assistance Trust Fund
$ 25.00
$ 2.00
TOTAL POLICY PREMIUM INCLUDING ASSESSMENTS AND ALL SURCHARGES $ 673.00
Insured Note: The portion of your premium for Hurricane Coverage is: $ 220.49
The portion of your premium for Non - Hurricane Coverage is: $ 425.51
RENEWAL NOTICES
Premium change due to coverage change $0.00.
Premium change due to rate increase /decrease $15.00.
FNIC HO 9 (08 14)
2
FEDERATED NATIONAL INSURANCE COMPANY
14050 NW 14th Street, Suite 180
Sunrise, FL 33323
Claims: 1- 800 - 293 -2532
Service: Contact Your Agent Listed Below
DECLARATION EFFECTIVE
11/20/2015
FEDERATED NATIONAL
Policy Number
FE- 0000517555 -02
Policy Period 12:01 AM Eastern Standard Time
FROM 11/20/2015 TO 11/20/2016
Agent Code
04024
Forms and Endorsements Applicable to this Policy:
FN IC HO 00 03 (04/14), FNIC HOPL (02/13), FNIC HO 64 (09/13)
Rating Information for your policy:
Form Type
HO -3
Year Built /
Verified
2007
Town / Row
House
YES
Construction
Type
Masonry
BCEGS
3
Territory
81
Wind /Hail
Exclusion
NO
Mun Code
Fire / Police
999 / 999
County
Pinellas
Occupancy
Owner
Use
Primary
No. of Families
1
Protection Class
3
Dist to Hydrant
1000 ft
Dist to Fire
Station
5 mi
Protective Device Credits
No Dec or Prior
Insurance Surcharge
N/A
Seasonal Surcharge
N/A
Age of Home Surcharge /
Credit
N/A
Burglar Alarm
NO
Fire Alarm
NO
Sprinkler
None
Terrain
Terrain B
Building Type
Townhouse
Roof Cover
(B) Non -FBC Equivalent
Roof Deck Attachment
(F) Unknown
Roof -Wall Connection
;G) Unknown or Unidentified
Secondary Water
Resistance
(B) No
Roof Shape
(A) Hip
Opening Protection
(L) Unknown or
Undetermined
FBC Wind Speed
120+ mph
FBC Wind Design
120 mph
A premium adjustment of $- 940.00 is included to reflect the building's wind loss mitigation features or construction
techniques that exist. Credits range from 0% to 90 %.
A premium adjustment of $- 127.51 is included to reflect the building code grade for your area. Adjustments range from a 5%
surcharge to a 46% credit.
AUTHORIZED BY:
GORDON JENNINGS
NAME
SIGNATURE
Lienholder Name and Address
Lienholder Name and Address
JP Morgan Chase Bank, NA
CITY OF CLEARWATER
ISAOA
ISAOA / ATIMA
PO Box 47020
112 S OSCEOLA AVE
Atlanta, GA. 30362
CLEARWATER, FL. 33756
Account Number
Account Number
1679886702
NOT APPLICABLE
3
FNIC HO 9 (08 14)
062854 -01 -00729
FEDERATED NATIONAL INSURANCE COMPANY DECLARATION EFFECTIVE
14050 NW 14th Street, Suite 180 11/20/2015 FEDERATED NATIONAL
Sunrise, FL 33323
Policy Number: FE- 0000517555 -02
NOTICES
PLEASE VISIT FEDNAT.COM TO VIEW YOUR APPLICABLE POLICY FORMS AND ENDORSEMENTS. CLICK
CUSTOMER SERVICE FOLLOWED BY THE E -FORMS LIBRARY OR TYPE THIS URL INTO YOUR INTERNET
BROWSER HTTP: / /WWW.FEDNAT.COM/ CUSTOMER - SERVICE /E- FORM - LIBRARY. YOU HAVE THE RIGHT TO
REQUEST AND OBTAIN WITHOUT CHARGE A PAPER OR ELECTRONIC COPY OF YOUR POLICY AND
ENDORSEMENTS BY CONTACTING YOUR AGENT OR CALLING CUSTOMER SERVICE AT (800) 293 -2532.
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.
YOUR POLICY PROVIDES COVERAGE FOR CATASTROPHIC GROUND COVER COLLAPSE THAT
RESULTS IN THE PROPERTY BEING CONDEMNED AND UNINHABITABLE. OTHERWISE,
YOUR POLICY DOES NOT PROVIDE COVERAGE FOR SINKHOLE LOSSES.
YOU MAY PURCHASE ADDITIONAL COVERAGE FOR SINKHOLE LOSSES FOR AN
ADDITIONAL PREMIUM.
FNIC HO 9 (08 14)
4