ENDORSEMENT DECLARATIONa
FEDERATED NATIONAL INSURANCE COMPANY
14050 NW 14th Street, Suite 180
Sunrise, FL 33323
Claims: 1- 800 - 293 -2532
Service: Contact Your Agent Listed Below
ENDORSEMENT DECLARATION EFFECTIVE
6/28/2016 FEDERATED NATIONAL
Policy Number
FE- 0000751094 -00
Policy Period 12:01 AM Standard Time
FROM 6/28/2016 TO 6/28/2017
Agent Code
01797
065791 -01 -00839
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 $ 487.00
Insured Note: The portion of your premium for Hurricane Coverage is: $ 101.00
The portion of your premium for Non - Hurricane Coverage is: $ 359.00
FNIC HO 9 (04 16)
2
Condo Association
PINEWOOD VILLAGE CONDO BLDG 4
24701 US HWY 19 N
SUITE 102
CLEARWATER, FL. 33763
FNIC HO 9 (04 16)
2
•
FEDERATED NATIONAL INSURANCE COMPANY ENDORSEMENT DECLARATION EFFECTIVE
14050 NW 14th Street, Suite 180 6/28/2016 FEDE FEDERATED ATIO
Sunrise, FL 33323
Claims: 1- 800 - 293 -2532
Service: Contact Your Agent Listed Below
Policy Number
FE- 0000751094 -00
Policy Period 12:01 AM Standard Time
FROM 6/28/2016 TO 6/28/2017
Agent Code
01797
Forms and Endorsements Applicable to this Policy:
HO 00 06 (04/91), FNIC HOPL (02/13), HO 04 90 (04/91), HO 23 70 (06/97), FNIC HO 32 (01/09), FNIC HO 04 (02/14), FNIC HO 05 (02/00), FNIC
HO 06 (02/00), FNIC HO 07 (02/00), FNIC HO 08 (02/00), FNIC HO 11 (09/13), FNIC HO 12 (02/00), FNIC HO 13 (02/00), FNIC HO 14 (02/14),
FNIC HO 31 (02/14), HO 04 32 (04/02), HO 04 96 (04/91), HO 04 13 (09/98), FNIC HO 61 (02/14), FNIC HO 64 (09/13), FNIC HO 10 (02/00), HO
01 09 (09/99), HO 17 32 (04/91), FNIC HO 29 (05/08)
[The Total Charge for this Endorsement is: $0.00]
[Endorsement Reason:] Updated roof material from shingle to concrete.
Rating Information for your policy:
Form Type
HO -6
Year Built /
Verified
1978
Town / Row
House
NO
Construction
Type
Masonry
BCEGS
99
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
YES
Burglar Alarm
NO
Fire Alarm
NO
Sprinkler
None
Terrain
Terrain B
Building Type
Condo
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
(C) Flat
Opening Protection
(L) Unknown or
Undetermined
FBC Wind Speed
120+ mph
FBC Wind Design
120 mph
A premium adjustment of $ 0.00 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 $ 0.00 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
VANDYK MORTGAGE CORPORATION ISAOA/
CITY OF CLEARWATER ISAOA/ATIMA
ATIMA
PO BOX 4748
2141 W BRISTOL RD
CLEARWATER, FL. 33758
FLINT, MI. 48507
Account Number
Account Number
76216104677
00000000
3
FNIC HO 9 (04 16)
FEDERATED NATIONAL INSURANCE COMPANY ENDORSEMENT DECLARATION EFFECTIVE
14050 NW 14th Street, Suite 180 6/28/2016 FEDERATED NATIONAL
Sunrise, FL 33323
Policy Number: FE- 0000751094 -00
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.
4
FNIC HO 9 (04 16)
065791 -01 -00837
HARBOR INSURANCE GROUP INC.
810 63RD AVE NORTH
ST. PETERSBURG, FL. 33702
Send To: CITY OF CLEARWATER ISAOA/ATIMA
PO BOX 4748
CLEARWATER, FL. 33758
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.
FEDERATED NATIONAL INSURANCE COMPANY
14050 NW 14th Street, Suite 180
Sunrise, FL 33323
Claims: 1- 800 - 293 -2532
Service: Contact Your Agent Listed Below
ENDORSEMENT DECLARATION EFFECTIVE
6/28/2016
FEDERATED # NATIONAL
Policy Number
FE-0000751094-00
Policy Period 12:01 AM Standard Time
FROM 6/28/2016 TO 6/28/2017
Agent Code
01797
Named Insured and Mailing Address:
Mary H Barefield
601 N Hercules Ave Apt 406
Clearwater, FL. 33765
Location of Residence Premises:
601 N Hercules Ave Apt 406
Clearwater, FL. 33765
Agent:
HARBOR INSURANCE GROUP INC.
810 63RD AVE NORTH
ST. PETERSBURG, FL. 33702
Phone: (727) 528 -2240
Coverage is only provided where a premium and a limit of liability is shown.
HURRICANE DEDUCTIBLE: [ 2% of coverage C / $ 400 ]
ALL OTHER PERILS DEDUCTIBLE: $1,000
SECTION I — PROPERTY COVERAGES
A - Dwelling
C - Personal Property
D - Loss of Use
SECTION II — LIABILITY COVERAGES
E — Personal Liability
F — Medical Payments
LIMIT OF LIABILITY ANNUAL PREMIUM
$20,000 $ 142.00
$20,000 $ 187.00
$8,000 INCL
$100,000
$1,000
INCL
INCL
OPTIONAL COVERAGES
Ordinance or Law Coverage 25% of coverage A INCL
Dwelling Age Credit/Surcharge $ 19.00
Electronic Equipment $2,000 INCL
Limited Fungi, Wet or Dry Rot, or Bacteria (Property) $10,000 INCL
Limited Fungi, Wet or Dry Rot, or Bacteria (Liability) $50,000 INCL
Loss Assessment $2,000 $ 5.00
Personal Property Replacement Cost $ 65.00
Special Coverage "A" ( HO -6) $20,000 $ 21.00
Water Back Up and Sump Overflow $5,000 $ 25.00
Claim Free Discount $- 4.00
1
FNIC HO 9 (04 16)