POLICY CHANGE SUMMARY (3)Page 1 of 11
��ITIZENS
PROPERTY INSURANCE CORPORATION
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
POLICY CHANGE SUMMARY
POLICY NUMBER: 01180862 - 2
POLICY PERIOD FROM 09/28/2016 TO 09/28/2017
at 12:01 a.m. Eastern lime
Transaction: RENEWAL
Item
Prior Policy Information
Amended Policy Information
Dwelling
Dwelling at 1466 FAIRMONT ST, CLEARWATER, FL
Dwelling Coverages
Coverage A
Coverage A - Dwelling
166,300
168,800
Most Recent Inflation Amount Ext
166300.00
168800.00
Coverage B
Coverage B - Other Structures Amount
3,330
3,380
Line Coverages
Coverage D
Coverage D - Fair Rental Value
16,630
16,880
Hurricane
Hurricane - Deductible Amount
16,630
16,880
RECEIVED
AUG 1 1 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.
I PCS 01 14
!TCITIZENS
PROPERTY INSURANCE CORPORATION
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Dwelling Fire DP -1 Basic Form Policy - Declarations
POLICY NUMBER: 01180862 - 2
POLICY PERIOD: FROM 09/28/2016 TO 09/28/2017
at 12:01 a.m. Eastern Time at the Location of the Residence Premises
Transaction: RENEWAL
Named Insured and Mailing Address:
First Named insured:
KRISTI JAGER
805 MANDALAY AVE
CLEARWATER BEACH, FL 33767 -1325
Phone Number: 727 - 204 -8694
Location Of Residence Premises:
1466 FAIRMONT ST
CLEARWATER FL 33755 -2715
County:PINELLAS
Agent: FI. Agent Lic. #: A123082
JAMES R HORDEN
Gayle Horden
10225 ULMERTON RD STE 9B
LARGO, FL 33771
Phone Number: 727 - 581 -4117
Citizens Agency ID#: 450
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
PROPERTY COVERAGES
A. Dwelling:
B. Other Structures *:
C. Personal Property:
D. Fair Rental Value *:
*Payments under Coverage "B° or "D" reduce Coverage "A" amount for the same loss (see policy).
LIABILITY COVERAGES
L. Personal Liability:
M. Medical Payments:
OTHER PROPERTY AND LIABILITY COVERAGES
Vandalism or Malicious Mischief
Extended Coverage
Florida Hurricane Catastrophe Fund Build -Up Premium:
Premium Adjustment Due To Allowable Rate Change:
Hurricane Deductible: $16,880 (10 %)
LIMIT OF LIABILITY
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 $408
Authorized By: Gayle Horden
$168,800
$3,380
$0
(See Policy)
$100,000
$2,000
(See Policy)
(See Policy)
SUBTOTAL:
Non - Hurricane Coverage is $276
N
0
ANNUAL PREMIUM
$518 irS
0
rn
is;g
$13
INCLUDED
Included
Included
$531
$23
$130
$700
=
IRE- I
III
BEMIS
Processed Date: 08/08/2016
I DEC DP1 D 12 15
Mortgageholder
Page 1 of 41
Page 2 of 41
CITIZENS
PROPERTY INSURANCE CORPORATION
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Dwelling Fire DP -1 Basic Form Policy - Declarations
Policy Number: 01180862 - 2 POLICY PERIOD: FROM 09/28/2016 TO 09/28/2017
First Named Insured: KRISTI JAGER at 12:01 a.m. Eastern lime at the Location of the Residence Premises
Forms and Endorsements applicable to this policy:
CIT DL 24 16 02 16, CIT DP -1 02 16, CIT DL 24 11 02 16, CIT DL 24 01 02 16, CIT 25 07 08
Rating/Underwriting Information
Year Built:
1985
Protective Device - Burglar Alarm:
N/A
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:
999
Roof Cover - FBC Wind Speed:
N/A
Municipal Code - Fire:
999
Roof Cover - FBC Wind Design:
N/A
Occupancy:
Tenant Occupied
Roof Deck Attachment:
Level A
Use:
Rental Property
Roof -Wall Connection:
Clips
Number of Families:
1
Secondary Water Resistance:
No
Protection Class:
2
Roof Shape:
Gable
Distance to Hydrant (ft.):
500
Opening Protection:
None
Distance to Fire Station (mi.):
2
A premium adjustment of ($331) 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 10% credit.
Your property coverage limits have been adjusted for inflation.
Your policy premium has decreased by ($57). Of this amount:
The premium difference due to an approved rate change is ($72)
The premium difference due to changes in your coverage is $13
The premium difference due to mandatory additional charges plus FHCF Build -up is $2
IDEC DP1D 12 15
Mortgageholder
CITIZENS
PROPERTY INSURANCE CORPORATION
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Dwelling Fire DP -1 Basic Form Policy - Declarations
Policy Number: 01180862 - 2 POLICY PERIOD: FROM 09/28/2016 TO 09/28/2017
First Named Insured: KRISTI JAGER at 12:01 a.m. Eastern lime 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 2nd Mortgagee
Name and Address
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
9900132706
DEC DP1D 12 15
Mortgageholder
Page 3 of 4
Page 4 of 41
CITIZENS
PROPERTY INSURANCE CORPORATION
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Dwelling Fire DP -1 Basic Form Policy - Declarations
Policy Number: 01180862 - 2 POLICY PERIOD: FROM 09/28/2016 TO 09/28/2017
First Named Insured: KRISTI JAGER at 12:01 a.m. Eastem Time at the Location of the Residence Premises
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.
NEITHER "FLOOD" NOR "ORDINANCE OR LAW"
COVERAGE IS PROVIDED IN THIS POLICY.
TO REPORT A 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.
IDEC DP1 D 12 15
Mortgageholder
2077 GAYLE HORDEN
JAMES R HORDEN
10225 ULMERTON RD STE 9B
LARGO, FL 33771
CITY OF CLEARWATER ISAOA ATIMA
PO BOX 4748
CLEARWATER, FL 33758 -4748