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RENEWAL DECLARATIONFEDERATED NATIONAL INSURANCE COMPANY 14050 NW 14th Street, Suite 180 Sunrise, FL 33323 Claims: 1- 800 - 293 -2532 Service: Contact Your Agent Listed Below RENEWAL DECLARATION EFFECTIVE 7/3/2016 FEL E ;t TED NATIONAL Policy Number F H- 0000160622 -03 Policy Period 12:01 AM Standard Time FROM 7/3/2016 TO 7/3/2017 Agent Code 05220 Named Insured and Mailing Address: Location of Residence Premises: Agent: Dwayne Kimball 1572 Tilley Ave CROSSLET INSURANCE SERVICES,INC 1572 Tilley Ave Clearwater, FL. 33756 13246 38 STREET NORTH Clearwater, FL. 33756 CLEARWATER, FL. 33762 Phone: (727) 471 -0818 Coverage is only provided where a premium and a limit of liability is shown. HURRICANE DEDUCTIBLE: [ 2% of coverage A / $3,260 ] ALL OTHER PERILS DEDUCTIBLE: $ 500 SINKHOLE LOSS DEDUCTIBLE : N/A 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 LIMIT OF LIABILITY ANNUAL PREMIUM $163,000 $1697.00 $1,630 INCL $81,500 INCL $32,600 INCL $300,000 $1,000 $ 15.00 INCL OPTIONAL COVERAGES Ordinance or Law Coverage 50% of coverage A $ 88.98 Superior Construction $- 254.55 Personal Property Replacement Cost $ 216.37 AOP Deductible $ 120.72 Dwelling Age Credit/Surcharge $- 221.83 Claim Free Discount $- 20.60 Building Code Compliance Grading $- 122.24 Windstorm Protective Devices $- 856.62 Loss Assessment $1,000 INCL Limited Fungi, Wet or Dry Rot, or Bacteria (Property) $25,000 $ 60.00 Limited Fungi, Wet or Dry Rot, or Bacteria (Liability) $50,000 INCL 1 FNIC HO 9 (04 16) 065526 -06 -00831 FEDERATED NATIONAL INSURANCE COMPANY 14050 NW 14th Street, Suite 180 Sunrise, FL 33323 Claims: 1- 800 - 293 -2532 Service: Contact Your Agent Listed Below RENEWAL DECLARATION EFFECTIVE 7/3/2016 FEDERATED NATIONAL ONAL Policy Number FH- 0000160622 -03 Policy Period 12:01 AM Standard Time FROM 7/3/2016 TO 7/3/2017 Agent Code 05220 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 $ 749.00 Insured Note: The portion of your premium for Hurricane Coverage is: $ 255.87 The portion of your premium for Non - Hurricane Coverage is: $ 466.13 RENEWAL NOTICES Premium change due to coverage change $0.00. Premium change due to rate increase /decrease $24.00. FNIC HO 9 (04 16) 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 RENEWAL DECLARATION EFFECTIVE 7/3/2016 FEDERATED ZONAL Policy Number FH- 0000160622 -03 Policy Period 12:01 AM Standard Time FROM 7/3/2016 TO 7/3/2017 Agent Code 05220 Forms and Endorsements Applicable to this Policy: FNIC 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 2013 Town / Row House NO 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 1 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 Dwelling Roof Cover (B) Non -FBC Equivalent Roof Deck Attachment (F) Unknown Roof -Wall Connection :G) Unknown or Unidentifiec Secondary Water Resistance (B) No Roof Shape (B) Other Opening Protection (L) Unknown or Undetermined FBC Wind Speed 120+ mph FBC Wind Design 120 mph A premium adjustment of $- 856.62 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 $- 122.24 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 Regions Bank d /b /a Regions Mortgage The City of Clearwater, ISAOA ATIMA ISAOA P.O.Box 4748 P.O.Box 200401 Clearwater, FL. 33758 Florence, SC. 29502 -0401 Account Number Account Number 0899084345 0899084345 3 FNIC HO 9 (04 16) 065526 -06 -00833 FEDERATED NATIONAL INSURANCE COMPANY RENEWAL DECLARATION EFFECTIVE 14050 NW 14th Street, Suite 180 7/3/2016 FEDER, TED NATIONAL Sunrise, FL 33323 Policy Number: FH- 0000160622 -03 NOTICES PLEASE VISIT FEDNAT.COM TO VIEW YOUR APPLICABLE POLICY FORMS AND ENDORSEMENTS. CLICK CUSTOMER SERVICE FOLLOWED BY INSURED LOGIN OR TYPE THIS URL INTO YOUR INTERNET BROWSER HTTP: / /WWW.FEDNAT.COM/ CUSTOMER - SERVICE /INSURED- LOGIN. 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. FN IC HO 9 (04 16) 4 065526 -06 -00829 CROSSLET INSURANCE SERVICES,INC 13246 38 STREET NORTH CLEARWATER, FL. 33762 Send To: THE CITY OF CLEARWATER, ISAOA ATIMA P.O.BOX 4748 CLEARWATER, FL. 33758 JUL r'2 1E OrF /C,k LEGISIA CS �N �EF� 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.