POLICY CHANGE SUMMARY - HOMEOWNERS HO-3 SPECIAL FORM POLICY - DECLARATIONS (2)<=r6-ITIZENS
PROPERTY INSURANCL CORPORA I ION
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
POLICY CHANGE SUMMARY
POLICY NUMBER: 01019052 - 3
POLICY PERIOD FROM 08/25/2017 TO 08/25/2018
at 12:01 a.m. Eastern Time
Transaction: AMENDED DECLARATIONS
Effective: 06/04/2018
Item
Prior Policy Information
Amended Policy Information
Policy Info
First Mortgagee Contact Ext
Policy 1st Mortgagee
Dwelling
Dwelling at 609 FAIRWOOD FOREST DR, CLEARWATER, FL
Additional Interests
Additional Interest: PLANET HOME LENDING LLC ISAOA
ATIMA (1st Mortgagee)
Added
Deleted
O _ i.1i. 'i._ Ort.:.,ii AND
LEGISLI r7 SRA/CS 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.
PCS 01 14
Page 1 of 1
CITIZENS
PROPERTY INSURANCE CORPORAOON
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Homeowners HO -3 Special Form Policy - Declarations
POLICY NUMBER: 01019052 - 3
POLICY PERIOD: FROM 08/25/2017 TO 08/25/2018
at 12:01 a.m. Eastern lime at the Location of the Residence Premises
Transaction: AMENDED DECLARATIONS
Effective: 06/04/2018
Named Insured and Mailing Address:
First Named Insured:
CARIN BLATT
609 Fairwood Forest Dr
CLEARWATER, FL 33759
Phone Number: 727-797-4482
Location Of Residence Premises:
609 FAIRWOOD FOREST DR
CLEARWATER FL 33759
County:PINELLAS
Agent: FI. Agent Lic. #: P056117
GAVIN INSURANCE & FINANCIAL
SERVICES, INC
CLIVE GAVIN
2270 DREW ST SUITE A
CLEARWATER, FL 33765
Phone Number: 727-799-4665
Citizens Agency ID#: 31716
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: $500
Sinkhole Loss Deductible: $16,800 (10%)
SECTION I - 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)
Sinkhole Loss Coverage
Florida Hurricane Catastrophe Fund Build -Up Premium:
Premium Adjustment Due To Allowable Rate Change:
Hurricane Deductible: $3,360 (2%)
LIMIT OF LIABILITY ANNUAL PREMIUM
$1,648
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 $1,541
Authorized By: CLIVE GAVIN
$168,000
$3,360
$42,010
$16,800
$100,000
$2,000
Included
(See Policy)
(See Policy)
SUBTOTAL:
Non -Hurricane Coverage is $704
$8
INCLUDED
$278
Included
$202
$2,136
$109
$0
$3
$2
$39
00038040001880000302
$2,289
Processed Date: 06/15/2018
DEC H03 07 16
Mortgageholder
Page 1 of 3
��ITIZENS
PROPERTY INSURANCE CORPORATION
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Homeowners HO -3 Special Form Policy - Declarations
Policy Number: 01019052 - 3 POLICY PERIOD: FROM 08/25/2017 TO 08/25/2018
First Named Insured: CARIN BLATT at 12:01 a.m. Eastern Time at the Location of the Residence Premises
Forms and Endorsements applicable to this policy:
CIT 04 86 07 17, CIT 04 90 01 13, CIT HO -3 07 17, CIT 04 96 02 16, CIT 23 94 02 16, CIT 24 07 08, CIT 04 85 07 17
Rating/Underwriting Information
Year Built:
1984
Protective Device - Burglar Alarm:
No
Town / Row House:
Yes
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:
2
Roof Shape:
Gable
Distance to Hydrant (ft.):
850
Opening Protection:
None
Distance to Fire Station (mi.):
4
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.
The Total Charge For This Endorsement is $0
ADDITIONAL NAMED INSURED(S)
Name Address
No Additional Named Insureds
ADDITIONAL INTEREST(S)
# Interest Type
1 2nd Mortgagee
Name and Address
CITY OF CLEARWATER ISAOA ATIA
112 S OSCEOLA AVE CLEARWATER, FL 33756-5106
Loan Number
RL1735
DEC H03 07 16
Mortgageholder
Page 2 of 3
CITIZENS
PROPERTY INSURANCE CORPORATION
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Homeowners HO -3 Special Form Policy - Declarations
Policy Number: 01019052 - 3 POLICY PERIOD: FROM 08/25/2017 TO 08/25/2018
First Named Insured: CARIN BLATT at 12:01 a.m. Eastem 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.
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.
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.
DEC H03 07 16
Mortgageholder
Page 3 of 3
00038040001880080303
00
1880 CLIVE GAVIN
GAVIN INSURANCE & FINANCIAL SERVICES, INC
2270 DREW ST
SUITE A
CLEARWATER, FL 33765
CITY OF CLEARWATER ISAOA ATIA
112 S OSCEOLA AVE
CLEARWATER, FL 33756-5106