POLICY CHANGE SUMMARY - RENEWALkfr
CITIZENS
I Rt)I L ii1Y INSURANCE CUItt'UltAlli)N
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
POLICY CHANGE SUMMARY
POLICY NUMBER: 01638015 - 3
POLICY PERIOD FROM 11/15/2017 TO 11/15/2018
at 12:01 a.m. Eastern Time
Transaction: RENEWAL
Item
Prior Policy Information
Amended Policy information
Property Address Info
Policy Address (1: 1573 GENTRY ST, Clearwater, FL)
City
CLEARWATER
Clearwater
County
PINELLAS
Pinellas
Dwelling
Dwelling at 1573 GENTRY ST, Clearwater, FL
Additional Interests
Additional Interest: (1st Mortgagee)
Added
Deleted
Additional Interest: REGIONS BANK ISAOA (1st Mortgagee)
Added
Dwelling Coverages
Coverage A
Coverage A - Dwelling
196,100
199,800
Most Recent Inflation Amount Ext
196100.00
199800.00
Coverage B
Coverage B - Other Structures Amount
3,920
4,000
Coverage C
Coverage C - Personal Property
49,030
49,960
Line Coverages
Coverage D
Coverage D - Loss of Use
19,610
19,980
Hurricane
Hurricane - Deductible Amount
3,922
3,996
Ordinance Or Law
Ordinance Or Law - Amount
49,030
49,950
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
PROPERIY INSURANCE CORPORATION
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Homeowners HO -3 Special Form Policy - Declarations
POLICY NUMBER: 01638015 - 3
POLICY PERIOD: FROM 11/15/2017 TO 11/15/2018
at 12:01 a.m. Eastern Time at the Location of the Residence Premises
Transaction: RENEWAL
Named Insured and Mailing Address:
First Named Insured:
Michael Jackson
1573 Gentry St
CLEARWATER, FL 33755
Phone Number: 727-446-6234
Location Of Residence Premises:
1573 GENTRY ST
Clearwater FL 33755-3519
County:Pinellas
Agent: FI. Agent Lic. #: A185178
PAUL MORRISON INS. & REAL ESTATE,
INC
PAUL MORRISON
PO Box 3646
Holiday, FL 34692
Phone Number: 727-934-5751
Citizens Agency ID#: 20238
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: $3,996 (2%)
LIMIT OF LIABILITY ANNUAL PREMIUM
$1,670
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 $1,556
Authorized By: PAUL MORRISON
$199,800
$4,000
$49,960
$19,980
$100,000
$2,000
Included
(See Policy)
$8
INCLUDED
$251
Included
SUBTOTAL: $1,929
Non -Hurricane Coverage is $483
$110
$0
$3
$2
$36
$2,080
00034956001492000402
Processed Date: 10/13/2017 =
DEC H03 07 16
Mortgageholder
Page 1 of 5
��ITIZENS
1'HUPEit I Y INSURANCE CiRPUHAI ION
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Homeowners HO -3 Special Form Policy - Declarations
Policy Number: 01638015 - 3 POLICY PERIOD: FROM 11/15/2017 TO 11/15/2018
First Named Insured: Michael Jackson
at 12:01 a.m. Eastern Time at the Location of the Residence Premises
Forms and Endorsements applicable to this policy:
CIT 04 96 02 16, CIT HO -3 07 17, CIT 04 90 01 13, CIT 24 07 08, CIT 04 85 07 17, CIT 04 86 07 17
Rating/Underwriting Information
Year Built:
19581
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:
Unknown
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:
Unknown
Use:
Primary
Roof -Wall Connection:
Unknown
Number of Families:
1
Secondary Water Resistance:
Unknown
Protection Class:
1
Roof Shape:
Gable
Distance to Hydrant (ft.):
200
Opening Protection:
Unknown
Distance to Fire Station (mi.):
2
A premium adjustment of $0 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 increased by $147. Of this amount:
The premium difference due to an approved rate change is $93
The premium difference due to changes in your coverage is $35
The premium difference due to mandatory additional charges plus FHCF Build-up is $19
DEC H03 07 16
Mortgageholder
Page 2 of 5
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CITIZENS
PROPEND INSURANCE CORPORAIION
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Homeowners HO -3 Special Form Policy - Declarations
Policy Number: 01638015 - 3 POLICY PERIOD: FROM 11/15/2017 TO 11/15/2018
First Named Insured: Michael Jackson
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
Name and Address
City of Clearwater
112 S OSCEOLA AVE CLEARWATER, FL 33756-5106
REGIONS BANK ISAOA
PO BOX 163169 FORT WORTH, TX 76161-3169
Loan Number
0009270100000000900414574
DEC H03 07 16
Mortgageholder
Page 3 of 5
3
00034956001492000403
‹rCITIZENS
PNOPtI;lY INSURANCE CURPORAIIUIJ
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Homeowners HO -3 Special Form Policy - Declarations
Policy Number: 01638015 - 3 POLICY PERIOD: FROM 11/15/2017 TO 11/15/2018
First Named Insured: Michael Jackson 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
(EITIZE N S
PROPERIY INSURANCE CORPORATION
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Homeowners HO -3 Special Form Policy - Declarations
Policy Number: 01638015 - 3 POLICY PERIOD: FROM 11/15/2017 TO 11/15/2018
First Named Insured: Michael Jackson 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.
00034956001492080404
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