HOMEOWNERS HO-3 SPECIAL FORM POLICY - DECLARATIONSIr�ITIZENS
PROPERLY INSURANCE CORPORANON
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Homeowners HO -3 Special Form Policy - Declarations
Policy Number: 02548753 - 2 POLICY PERIOD: FROM 08/09/2018 TO 08/09/2019
First Named Insured: FRANKYE D SALPH 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 08 18, CIT 24 07 08, CIT 04 85 08 18, CIT 04 86 08 18, CIT 04 90 01 13
Rating/Underwriting Information
Year Built:
1950
Protective Device - Burglar Alarm:
No
Town / Row House:
No
Protective Device - Fire Alarm:
No
Construction Type:
Frame
Protective Device - Sprinkler:
None
BCEGS:
Ungraded
No Prior Insurance Surcharge:
No
Territory / Coastal Territory:
081 / 00
Terrain:
C
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:
Clips
Number of Families:
1
Secondary Water Resistance:
Yes
Protection Class:
1
Roof Shape:
Hip
Distance to Hydrant (ft.):
600
Opening Protection:
None
Distance to Fire Station (mi.):
1
A premium adjustment of ($1,059) 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 ($5). Of this amount:
The premium difference due to an approved rate change is ($103)
The premium difference due to changes in your coverage is $96
The premium difference due to mandatory additional charges plus FHCF Build-up is $2
ADDITIONAL NAMED INSURED(S)
Name Address
No Additional Named Insureds
ADDITIONAL INTEREST(S)
# Interest Type
1 1st Mortgagee
Name and Address
City Of Clearwater, Isaoa/Atima
112 S OSCEOLA AVE CLEARWATER, FL 33756-5106
Loan Number
FL -2139849
DEC H03 08 18
Mortgageholder
Page 2 of 4
!'CITIZENS
PROPERTY INSURANCE CORPORATION
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Homeowners HO -3 Special Form Policy - Declarations
Policy Number: 02548753 - 2 POLICY PERIOD: FROM 08/09/2018 TO 08/09/2019
First Named Insured: FRANKYE D SALPH at 12:01 a.m. Eastern lime 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.
TO REPORT A LOSS OR CLAIM CALL 866.411.2742
IN CASE OF LOSS TO COVERED PROPERTY, YOU MUST TAKE REASONABLE EMERGENCY MEASURES SOLELY TO PROTECT
THE PROPERTY FROM FURTHER DAMAGE IN ACCORDANCE WITH THE POLICY PROVISIONS.
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.
DEC H03 08 18
Mortgageholder
Page 3 of 4
00038204001201000403
MSS
��ITIZENS
PROPERTY INSURANCE CORPORATION
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
POLICY CHANGE SUMMARY
POLICY NUMBER: 02548753 - 2
POLICY PERIOD FROM 08/09/2018 TO 08/09/2019
at 12:01 a.m. Eastern Time
Transaction: RENEWAL
Item
Prior Policy Information
Amended Policy Information
Policy Info
Billing Contact: PRIME RATE PREMIUM FINANCE CORP INC
Added
Deleted
Property Address Info
Policy Address (1: 1005 OSAGE ST, CLEARWATER, FL)
Address Type
Home
Dwelling
Dwelling at 1005 OSAGE ST, CLEARWATER, FL
Roof Remaining Useful Life (years)
20
19
Dwelling Coverages
Coverage A
Coverage A - Dwelling
136,000
149,600
Coverage A - Loss Settlement
Replacement Cost
Coverage B
Coverage B - Other Structures Amount
2,720
2,990
Coverage C
Coverage C - Personal Property
34,000
37,400
Line Coverages
Coverage D
Coverage D - Loss of Use
13,600
14,960
Hurricane
Hurricane - Deductible Amount
2,720
2,992
Ordinance Or Law
Ordinance Or Law - Amount
34,000
37,400
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
kf
CITIZENS
PROPERTY INSURANCE CORPORATION
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Homeowners HO -3 Special Form Policy - Declarations
POLICY NUMBER: 02548753 - 2
POLICY PERIOD: FROM 08/09/2018 TO 08/09/2019
at 12:01 a.m. Eastern Time at the Location of the Residence Premises
Transaction: RENEWAL
Named Insured and Mailing Address:
First Named Insured:
FRANKYE D SALPH
1005 OSAGE ST
CLEARWATER, FL 33755-1837
Phone Number: 727-439-1079
Location Of Residence Premises:
1005 OSAGE ST
CLEARWATER FL 33755-1837
County:PINELLAS
Agent: FI. Agent Lic. #: A315827
LAAKE FINANCIAL SERVICES,INC
AMBER LAAKE
1070 KAPP DRIVE
CLEARWATER, FL 33765
Phone Number: 727-443-4571
Citizens Agency ID#: 20540
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 Hurricane Deductible: $2,992 (2%)
LIMIT OF LIABILITY ANNUAL PREMIUM
SECTION I - PROPERTY COVERAGES $747
A. Dwelling : $149,600
B. Other Structures: $2,990
C. Personal Property: $37,400
D. Loss of Use: $14,960
SECTION 1I - LIABILITY COVERAGES
E. Personal Liability: $100,000
F. Medical Payments: $2,000
OTHER COVERAGES
Personal Property Replacement Cost Included
Ordinance or Law Limit (25% of Cov A) (See Policy)
Florida Hurricane Catastrophe Fund Build -Up Premium:
Premium Adjustment Due To Allowable Rate Change:
MANDATORY ADDITIONAL CHARGES:
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 $536
Authorized By: AMBER LAAKE
SUBTOTAL:
Non -Hurricane Coverage is $439
$6
INCLUDED
$112
Included
$865
$39
$71
$2
$17
$994
Processed Date: 06/19/2018
DEC HO3 08 18
Mortgageholder
Page 1 of 4
00038204001201000402
CITIZENS
PROPERTY INSURANCE CORPORATION
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Homeowners HO -3 Special Form Policy - Declarations
Policy Number: 02548753 - 2 POLICY PERIOD: FROM 08/09/2018 TO 08/09/2019
First Named Insured: FRANKYE D SALPH at 12:01 a.m. Eastern Time at the Location of the Residence Premises
THIS POLICY CONTAINS LIMITS ON CERTAIN COVERED LOSSES, ALL SUBJECT TO THE TERMS AND CONDITIONS OF YOUR
POLICY. THESE LIMITS MAY INCLUDE A $10,000 LIMIT ON COVERAGE FOR COVERED LOSSES CAUSED BY ACCIDENTAL
DISCHARGE OR OVERFLOW OF WATER OR STEAM FROM SPECIFIED HOUSEHOLD SYSTEMS, SEEPAGE OR LEAKAGE OF
WATER OR STEAM, CONDENSATION, MOISTURE OR VAPOR, AS DESCRIBED AND INSURED IN YOUR POLICY (HEREAFTER
COLLECTIVELY REFERRED TO AS ACCIDENTAL DISCHARGE OF WATER IN THIS PARAGRAPH). AS ANOTHER EXAMPLE,THERE
IS ALSO LIMIT OF $3,000 APPLICABLE TO REASONABLE EMERGENCY MEASURES TAKEN TO PROTECT COVERED PROPERTY
FROM FURTHER DAMAGE BY ACCIDENTAL DISCHARGE OF WATER. THE AMOUNT WE PAY FOR THE NECESSARY REASONABLE
EMERGENCY MEASURES YOU TAKE SOLELY TO PROTECT COVERED PROPERTY FROM FURTHER DAMAGE BY ACCIDENTAL
DISCHARGE OF WATER WILL BE DEDUCTED FROM THE $10,000 LIMIT ON COVERAGE FOR ACCIDENTAL DISCHARGE OF
WATER.
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 866.411.2742.
DEC H03 08 18
Mortgageholder
Page 4 of 4
00
1201 AMBER LAAKE
LAAKE FINANCIAL SERVICES,INC
1070 KAPP DRIVE
CLEARWATER, FL 33765
CITY OF CLEARWATER, ISAOA/ATIMA
112 S OSCEOLA AVE
CLEARWATER, FL 33756-5106