POLICY CHANGE SUMMARY - HOMEOWNERS HO-3 SPECIAL FORM POLICY - DECLARATIONS!ITIZENS
PROPERTY INSURANCE CORPORAIION
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
POLICY CHANGE SUMMARY
POLICY NUMBER: 00960204 - 2 POLICY PERIOD FROM 08/07/2016 TO 08/07/2017
at 12:01 a.m. Eastern Time
Transaction: RENEWAL
Item
Prior Policy Information
Amended Policy Information
Dwelling
Dwelling at 200 S AURORA AVE, CLEARWATER, FL
Dwelling Coverages
Coverage A
Coverage A - Dwelling
140,700
142,800
Most Recent Inflation Amount Ext
140700.00
142800.00
Coverage C
Coverage C - Personal Property
35,180
35,710
Line Coverages
Coverage D
Coverage D - Loss of Use
14,070
14,280
Hurricane
Hurricane - Deductible Amount
2,814
2,856
Ordinance Or Law
Ordinance Or Law - Amount
35,180
35,700
RECEIVED
JUN 2 3 2016
OFFICIAL RECORDS AND
LEGISLATIVE SRVCS DEPT
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
CITIZENS
PNOPENlY INSUNANC L CORPOUTION
CITIZENS PROPERTY INSURANCE CORPORATION '
301 W BAY ST
JACKSONVILLE FL 32202
Homeowners HO-3 Special Form Policy - Declarations
POLICY NUMBER: 00960204 - 2
POLICY PERIOD: FROM 08/07/2016 TO 08/07/2017
at 12:01 a.m. Eastem Time at the Location of the Residence F remises
Transaction: RENEWAL
Named Insured and Mailing Address:
First Named Insured:
MANDIE CALDWELL
200 S AURORA AVE
CLEARWATER, FL 33765 -3520
Phone Number: 863 - 624 -4274
Location Of Residence Premises:
200 S AURORA AVE
CLEARWATER FL 33765
County:PINELLAS
Agent: FI. Agent Lic. #: A108315
FIRST AMERICAN PROPERTY &
CASUALTY INSURANCE COMPANY
Stephanie Hales
199 AVENUE B NW, SUITE #300
WINTER HAVEN, FL 33881
Phone Number: 866 - 320 -4274
Citizens Agency ID#: 23935
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: $2,500
SECTION 1- 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 Cov A)
Florida Hurricane Catastrophe Fund Build -Up Premium:
Premium Adjustment Due To Allowable Rate Change:
Hurricane Deductible: $2,856 (2 %)
LIMIT OF LIABILITY ANNUAL PREMIUM
$592
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 $680
Authorized By: Stephanie Hales
$142,800
$0
$35,710
$14,280
$100,000
$2,000
Included
(See Policy)
SUBTOTAL:
Non - Hurricane Coverage is $328
$6
INCLUDED
$89
Included
$687
$40
$281
$3
$2
$18
$1,031
Processed Date: 06/17/2016
DEC HO3 07 16
Mortgageholder
Page 1 of 5
H 011 III I g fl l I H H I HI
Page 2of51
?ITIZENS
PROPERTY INSURANCE CORPORATION
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Homeowners HO -3 Special Form Policy - Declarations
Policy Number: 00960204 - 2 POLICY PERIOD: FROM 08/07/2016 TO 08/07/2017
First Named Insured: MANDIE CALDWELL at 12:01 a.m. Eastern Time at the Location of the Residence Premises
Forms and Endorsements applicable to this policy:
CIT 24 07 08, CIT 04 90 01 13, CIT 04 96 02 16, CIT 04 12 02 16, CIT HO -3 07 16
Rating /Underwriting Information
Year Built:
1955
a 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:
FBC Equivalent
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:
Level A
Use:
Primary
Roof -Wall Connection:
Toe Nail
Number of Families:
1
Secondary Water Resistance:
No
Protection Class:
2
Roof Shape:
Hip
Distance to Hydrant (ft.):
500
Opening Protection:
None
Distance to Fire Station (mi.):
2
A premium adjustment of ($576) 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 ($88). Of this amount:
The premium difference due to an approved rate change is ($107)
The premium difference due to changes in your coverage is $17
The premium difference due to mandatory additional charges plus FHCF Build -up is $2
IDEC H03 07 16
Mortgageholder
nn
4 CITIZENS
PROPERTY INSURANCE CORPORATION
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Homeowners HO -3 Special Form Policy - Declarations
Policy Number: 00960204 - 2 POLICY PERIOD: FROM 08/07/2016 TO 08/07/2017
First Named Insured: MANDIE CALDWELL at 12:01 a.m. Eastem Time at the Location of the Residence Premises
ADDITIONAL NAMED INSURED(S)
Name Address
, No Additional Named Insureds
ADDITIONAL INTEREST(S)
# Interest Type
1 2nd Mortgagee
2 1st Mortgagee
3 3rd Mortgagee
Name and Address
US BANK NATIONAL ASSOCATION ISAOA ATIMA
PO BOX 7298 CARE OF US BANK HOME MORTGAGE
SPRINGFIELD, OH 45501 -7298
US BANK NA ISAOA C/O US BANK HOME MORTGAGE
PO BOX 7298 SPRINGFIELD, OH 45501 -7298
CITY OF CLEARWATER ISAOA ATIMA
PO BOX 4748 CLEARWATER, FL 33758-4748
Loan Number
2746366
9902746366
DEC H03 07 16
Mortgageholder
Page 3 of 5
CITIZENS
VROIERIY INSURANCE CORPORANON
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Homeowners HO -3 Special Form Policy - Declarations
Policy Number: 00960204 - 2 POLICY PERIOD: FROM 08/07/2016 TO 08/07/2017
First Named Insured: MANDIE CALDWELL at 12:01 a.m. Eastern 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.
YOUR POLICY PROVIDES COVERAGE FOR A
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.
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.
DEC H03 07 16
Mortgageholder
Page 4 of 5
CITIZENS
PROPERTY INSURANCE CORPORATION
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Homeowners HO -3 Special Form Policy - Declarations
Policy Number: 00960204 - 2 POLICY PERIOD: FROM 08/07/2016 TO 08/07/2017
First Named Insured: MANDIE CALDWELL at 12:01 a.m. Eastem Time at the Location of the Residence Premises
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 H03 07 16
Mortgageholder
Page 5 of 5
00053146001402080404
'! 1111 II 11 1111 111111
1402 STEPHANIE HALES
FIRST AMERICAN PROPERTY & CASUALTY INSURANCE COMPANY
199 AVENUE B NW, SUITE #300
WINTER HAVEN, FL 33881
CITY OF CLEARWATER ISAOA ATIMA
PO BOX 4748
CLEARWATER, FL 33758 -4748