POLICY CHANGE SUMMARY (2)Page 1 of 1 I
��ITIZENS
PROPERTY INSIIRANCE CORPORATION
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
POLICY CHANGE SUMMARY
POLICY NUMBER: 01347515 - 2
POLICY PERIOD FROM 09/17/2016 TO 09/17/2017
at 12:01 a.m. Eastern Time
Transaction: RENEWAL
Item
Prior Policy Information
Amended Policy Information
Dwelling
Dwelling at 1633 HARVARD ST, CLEARWATER, FL
Dwelling Coverages
Coverage A
Coverage A - Dwelling
155,400
157,700
Most Recent Inflation Amount Ext
155400.00
157700.00
Coverage B
Coverage B - Other Structures Amount
3,110
3,150
Coverage C
Coverage C - Personal Property
38,850
39,430
Line Coverages
Coverage D
Coverage D - Loss of Use
15,540
15,770
Hurricane
Hurricane - Deductible Amount
7,770
7,885
Ordinance Or Law
Ordinance Or Law - Amount
38,850
39,430
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.
IPCS 01 14
Page 1 of 51
CITIZENS
PROPERTY INSURANCE CONPORAUON
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Homeowners HO -3 Special Form Policy - Declarations
POLICY NUMBER: 01347515 - 2
POLICY PERIOD: FROM 09/17/2016 TO 09/17/2017
at 12:01 a.m. Eastem lime at the Location of the Residence Premises
Transaction: RENEWAL
Named Insured and Mailing Address:
First Named Insured:
EMSUD KURTOVIC
1633 HARVARD ST
CLEARWATER, FL 33755 -6425
Phone Number: 727 -444 -0602
Location Of Residence Premises:
1633 HARVARD ST
CLEARWATER FL 33755 -6425
County:PINELLAS
Agent: FL Agent Lic. #: A134410
KATHERINE JONES INSURANCE
AGENCY, INC.
KATHERINE JONES
575 S Hercules Ave Ste 604
Clearwater, FL 33764
Phone Number: 727 -447 -8989
Citizens Agency ID#: 25642
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 t - 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
Ordinance or Law Limit (25% of Coy A)
Florida Hurricane Catastrophe Fund Build -Up Premium:
Premium Adjustment Due To Allowable Rate Change:
Hurricane Deductible: $7,885 (5 %)
LIMIT OF LIABILITY ANNUAL PREMIUM
$580
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 $570
Authorized By: KATHERINE JONES
$157,700
$3,150
$39,430
$15,770
$100,000
$2,000
(See Policy)
SUBTOTAL:
Non - Hurricane Coverage is $288
$6
INCLUDED
Included
$586
$34
$238
$3
$2
$15
$878
Processed Date: 07/28/2016
DEC H03 07 16
Mortgageholder
Page 2of5J
��ITIZENS
PROPERTY INSURANCE CORPORATION
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Homeowners HO -3 Special Form Policy - Declarations
Policy Number: 01347515 - 2 POLICY PERIOD: FROM 09/17/2016 TO 09/17/2017
First Named Insured: EMSUD KURTOVIC 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 96 02 16, CIT HO -3 07 16
Rating /Underwriting Information
Year Built:
1952
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 C
Use:
Primary
Roof -Wall Connection:
Toe Nail
Number of Families:
1
Secondary Water Resistance:
Yes
Protection Class:
2
Roof Shape:
Hip
Distance to Hydrant (ft.):
500
Opening Protection:
None
Distance to Fire Station (mi.):
2
A premium adjustment of ($524) 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 ($76). Of this amount:
The premium difference due to an approved rate change is ($91)
The premium difference due to changes in your coverage is $10
The premium difference due to mandatory additional charges plus FHCF Build -up is $5
DEC H03 07 16
Mortgageholder
CITIZENS
PROPERTY INSURANCE CORPORATION
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Homeowners HO-3 Special Form Policy - Declarations
Policy Number: 01347515 - 2 POLICY PERIOD: FROM 09/17/2016 TO 09/17/2017
First Named Insured: EMSUD KURTOVIC at 12:01 a.m. Eastern Time at the Location of the Residence Premises
ADDITIONAL NAMED INSURED(S)
Name
Medina Kurtovic
Address
1633 HARVARD ST CLEARWATER, FL 33755 -6425
ADDITIONAL INTEREST(S)
# Interest Type
1 1st Mortgagee
2 2nd Mortgagee
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
0354564585
DPA -1476
MM
s
DEC H03 07 16
Mortgageholder
Page 3of51
Page 4 of 51
CITIZENS
PR01'ERTY INSIIRANCE CORPORANON
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Homeowners HO -3 Special Form Policy - Declarations
Policy Number: 01347515 - 2 POLICY PERIOD: FROM 09/17/2016 TO 09/17/2017
First Named Insured: EMSUD KURTOVIC 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.
I DEC H03 07 16
Mortgageholder
CITIZENS
PROPERTY INSURANCE CORPORATION
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Homeowners HO-3 Special Form Policy - Declarations
Policy Number: 01347515 - 2 POLICY PERIOD: FROM 09/17/2016 TO 09/17/2017
First Named Insured: EMSUD KURTOVIC at 12:01 a.m. Eastem Time at the Location of the Residence Premises
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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.
I DEC H03 07 16
Mortgageholder
Page 5 of 51
00
4760 KATHERINE JONES
KATHERINE JONES INSURANCE AGENCY, INC.
575 S HERCULES AVE STE 604
CLEARWATER, FL 33764
CITY OF CLEARWATER ISAOA ATIMA
PO BOX 4748
CLEARWATER, FL 33758 -4748