POLICY CHANGE SUMMARYCITIZENS
PROPERTY INSURANCE CORPORATION
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
POLICY CHANGE SUMMARY
POLICY NUMBER: 00895387 - 2 POLICY PERIOD FROM 07/29/2016 TO 07/29/2017
at 12:01 a.m. Eastern Time
Transaction: RENEWAL
This summary is for informational purposes only and does not change any of the terms or provisions on your policy. Please
carefully review your policy Declarations and any attached forms for a complete description of coverage.
PCS 01 14
Page 1 of 1
Prior Policy Information
Amended Policy Information
Property Address Info
Policy Address (1: Location 1)
Coastal Construction Control Line
Unknown
Out
Coastal Barrier Resources System
Unknown
Out
Dwelling
Dwelling at 1429 SPRINGDALE ST, CLEARWATER, FL
Dwelling Coverages
Coverage A
Coverage A - Dwelling
112,600
114,300
Most Recent Inflation Amount Ext
112600.00
114300.00
Coverage B
Coverage B - Other Structures Amount
2,250
2,290
Coverage C
Coverage C - Personal Property
28,150
28,580
Line Coverages
Coverage D
Coverage D - Loss of Use
11,260
11,430
Hurricane
Hurricane - Deductible Amount
2,252
2,286
Ordinance Or Law
Ordinance Or Law - Amount
28,150
28,580
Sinkhole
Sinkhole - Deductible Amount
11,260
11,430
This summary is for informational purposes only and does not change any of the terms or provisions on your policy. Please
carefully review your policy Declarations and any attached forms for a complete description of coverage.
PCS 01 14
Page 1 of 1
Page 1 of 41
ITIZEN
C s
PROPERTY INSURANCE CORPORATION
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Homeowners HO -3 Special Form Policy - Declarations
POLICY NUMBER: 00895387 - 2
POLICY PERIOD: FROM 07/29/2016 TO 07/29/2017
at 12:01 a.m. Eastem Time at the Location of the Residence Premises
Transaction: RENEWAL
Named Insured and Mailing Address:
First Named Insured:
LORI RICE
1429 SPRINGDALE ST
CLEARWATER, FL 33755 -2745
Phone Number: 727 -415 -9191
Location Of Residence Premises:
1429 SPRINGDALE ST
CLEARWATER FL 33755
County:PINELLAS
Agent: FI. Agent Lic. #: E184683
SEIBERT INSURANCE AGENCY INC
KARYN ROELING
5121 EHRLICH ROAD STE 111
TAMPA, FL 33624
Phone Number: 813 - 960 -4672
Citizens Agency ID#: 27208
Additional Named Insured: Please refer to "ADDITIONAL NAMED INSURED(S)" section for details
Coverage is only provided where a premium and a limit of liability is shown
All Other Perils Deductible: $1,000
Sinkhole Loss Deductible: $11,430 (10 %)
SECTION I - PROPERTY COVERAGES
A. Dwelling :
B. Other Structures:
C. Personal Property:
D. Loss of Use:
SECTION II - LIABILITY COVERAGES
E. Personal Liability:
F. Medical Payments:
OTHER COVERAGES
Personal Property Replacement Cost
Ordinance or Law Limit (25% of Coy A)
Sinkhole Loss Coverage
Florida Hurricane Catastrophe Fund Build -Up Premium:
Premium Adjustment Due To Allowable Rate Change:
Hurricane Deductible: $2,286 (2 %)
LIMIT OF LIABILITY ANNUAL PREMIUM
$1,051
MANDATORY ADDITIONAL CHARGES:
2012 Florida Insurance Guaranty Association (FIGA) Regular Assessment
Emergency Management Preparedness and Assistance Trust Fund (EMPA)
Tax - Exempt Surcharge
TOTAL POLICY PREMIUM INCLUDING ASSESSMENTS AND ALL SURCHARGES:
The portion of your premium for:
Hurricane Coverage is $1,063
Authorized By: KARYN ROELING
$114,300
$2,290
$28,580
$11,430
$100,000
$2,000
Included
(See Policy)
(See Policy)
SUBTOTAL:
Non- Hurricane Coverage is $390
$6
INCLUDED
$178
Included
$138
$1,373
$63
$17
$4
$2
$25
$1,484
Processed Date: 06/09/2016 MIN
I DEC H03 07 16
Additional Interest
��ITIZENS
PROPERTY INSURANCE CORPORATION
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Homeowners HO -3 Special Form Policy - Declarations
Policy Number: 00895387 - 2 POLICY PERIOD: FROM 07/29/2016 TO 07/29/2017
First Named Insured: LORI RICE
at 12:01 a.m. Eastern Time at the Location of the Residence Premises
Forms and Endorsements applicable to this policy:
CIT 04 90 01 13, CIT 04 96 02 16, CIT HO -3 07 16, CIT 23 94 02 16, CIT 24 07 08, HO 04 10 10 00
Rating /Underwriting Information
Year Built:
1957
Protective Device - Burglar Alarm:
No
Town / Row House:
No
Protective Device - Fire Alarm:
No
Construction Type:
Masonry
Protective Device - Sprinkler:
None
BCEGS:
Ungraded
No Prior Insurance Surcharge:
No
Territory / Coastal Territory:
081 / 00
Terrain:
B
Wind / Hail Exclusion:
No
Roof Cover:
Unknown
Municipal Code - Police:
251
Roof Cover - FBC Wind Speed:
N/A
Municipal Code - Fire:
251
Roof Cover - FBC Wind Design:
N/A
Occupancy:
Owner Occupied
Roof Deck Attachment:
Unknown
Use:
Primary
Roof -Wall Connection:
Unknown
Number of Families:
1
Secondary Water Resistance:
Unknown
Protection Class:
2
Roof Shape:
Gable
Distance to Hydrant (ft.):
800
Opening Protection:
Unknown
Distance to Fire Station (mi.):
4
A premium adjustment of $0 is included to reflect the building's wind loss mitigation features or construction techniques that exists.
A premium adjustment of $0 is included to reflect the building code effectiveness grade for your area. Adjustments range from a 2%
surcharge to a 13% credit.
Your property coverage limits have been adjusted for inflation.
Your policy premium has decreased by ($114). Of this amount:
The premium difference due to an approved rate change is ($139)
The premium difference due to changes in your coverage is $21
The premium difference due to mandatory additional charges plus FHCF Build -up is $4
DEC H03 07 16
Additional Interest
Page 2 of 4
Page 3 of 41
��ITIZENS
PROPERTY INSURANCE CORPORATION
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Homeowners HO -3 Special Form Policy - Declarations
Policy Number: 00895387 - 2 POLICY PERIOD: FROM 07/29/2016 TO 07/29/2017
First Named Insured: LORI RICE at 12:01 a.m. Eastern Time at the Location of the Residence Premises
ADDITIONAL NAMED INSURED(S)
Name Address
No Additional Named Insureds
ADDITIONAL INTEREST(S)
# Interest Type
1 1st Mortgagee
2 Additional Interest
Name and Address
WELLS FARGO BANK NA 936 ISAOA
PO BOX 100515 FLORENCE, SC 29502 -0515
City of Clearwater ISAOA ATIMA
PO BOX 4748 CLEARWATER, FL 33758 -4748
Loan Number
0379209513
I DEC H03 07 16
Additional Interest
?'ITIZENS
PROPERTY INSURANCE CORPORATION
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Homeowners HO-3 Special Form Policy - Declarations
Policy Number: 00895387 - 2 POLICY PERIOD: FROM 07/29/2016 TO 07/29/2017
First Named Insured: LORI RICE at 12:01 a.m. Eastem Time at the Location of the Residence Premises
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.
IN CASE OF A LOSS TO COVERED PROPERTY, YOU MUST TAKE REASONABLE EMERGENCY MEASURES SOLELY
TO PROTECT THE PROPERTY FROM FURTHER DAMAGE IN ACCORDANCE WITH THE POLICY PROVISIONS
(MAY NOT EXCEED THE GREATER OF $3,000 OR 1% OF YOUR COVERAGE A LIMIT OF LIABILITY UNLESS YOU
CALL US FIRST AND RECEIVE OUR APPROVAL). PROMPT NOTICE OF THE LOSS MUST BE GIVEN TO US OR
YOUR INSURANCE AGENT. EXCEPT FOR REASONABLE EMERGENCY MEASURES, THERE IS NO COVERAGE
FOR REPAIRS THAT BEGIN BEFORE THE EARLIER OF: (A) 72 HOURS AFTER WE ARE NOTIFIED OF THE LOSS, (B)
THE TIME OF LOSS INSPECTION BY US, OR (C) THE TIME OF OTHER APPROVAL BY US. TO REPORT A LOSS OR
CLAIM CALL 866.411.2742
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 888.685.1555.
DEC HO3 07 16
Additional Interest
Page 4 of 4
00
6272 KARYN ROELING
SEIBERT INSURANCE AGENCY INC
5121 EHRLICH ROAD STE 111
TAMPA, FL 33624
CITY OF CLEARWATER ISAOA ATIMA
PO BOX 4748
CLEARWATER, FL 33758 -4748