POLICY CHANGE SUMMARY (6)(CITIZENS
PROINIfi3Y INSURANCE: (ORYORAIION
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
POLICY CHANGE SUMMARY
POLICY NUMBER: 00674216 - 5
POLICY PERIOD FROM 06/18/2019 TO 06/18/2020
at 12:01 a.m. Eastern Time
Transaction: RENEWAL
Dwelling at 626 FAIRMONT ST, CLEARWATER, FL
Additional Interests
Amended Poi
Additional Interest: (1st Mortgagee)
Added
Deleted
Additional Interest: CITIMORTGAGE INC ISAOA (1st
Mortgagee)
Addl Int Eff Date
06/18/2018
Added
06/18/2019
Dwelling Coverages
Coverage A
Coverage A - Dwelling
Coverage B
154,100
158,300
Coverage B - Other Structures Amount
Coverage C
3,080
3,170
Coverage C - Personal Property
Line Coverages
Coverage D
38,530
39,580
Coverage D - Loss of Use
Hurricane
15,410
15,830
Hurricane - Deductible Amount
Ordinance Or Law
3,082
3,166
Ordinance Or Law - Amount
38,530
39,580
Sinkhole
Sinkhole - Deductible Amount
15,410
15,830
RECEIVED
MAY 13 2019
OFFICIAL RECORDS AND
LEGISLATIVE SfkVCS 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
Pt43;3'3ik3Y MU•RANO: CORPORA; N)
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Homeowners HO -3 Special Form Policy - Declarations
POLICY NUMBER: 00674216 - 5
POLICY PERIOD: FROM 06/18/2019 TO 06/18/2020
at 12:01 a.m. Eastern Time at the Location of the Residence Premises
Transaction: RENEWAL
Named Insured and Mailing Address:
First Named Insured:
MARY COONEY
626 FAIRMONT ST
CLEARWATER, FL 33755-2503
Phone Number: 727-441-9798
Primary Email Address: No Email Address
On File
Additional Named Insured: Please refer to "ADDITIONAL NAMED INSURED(S)" section for details
Location Of Residence Premises:
626 FAIRMONT ST
CLEARWATER FL 33755
County:PINELLAS
Agent: Fl. Agent Lic. #: E036207
DAVID TAPIA INSURANCE AGENCY INC.
DAVID TAPIA
133 N Garden Ave
Clearwater, FL 33755
Phone Number: 727-449-8800
Citizens Agency ID#: 27044
Coverage is only provided where a premium and a limit of liability is shown
All Other Perils Deductible: $1,000
Sinkhole Loss Deductible: $15,830 (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
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: $3,166 (2%)
LIMIT OF LIABILITY ANNUAL PREMIUM
$1,104
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 $781
$158,300
$3,170
$39,580
$15,830
$100,000
$2,000
(See Policy)
(See Policy)
SUBTOTAL:
Non -Hurricane Coverage is $582
$6
INCLUDED
Included
$196
$1,306
$57
$0
$2
$24
$1,389
Authorized By: DAVID TAPIA Processed Date: 04/28/2019
DEC H03 01 19
Mortgageholder
Page 1 of 5
CITIZENS
YI41;PlifiiY INSURANCE. CGRYilfcaf li)N
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Homeowners HO -3 Special Form Policy - Declarations
Policy Number: 00674216 - 5 POLICY PERIOD: FROM 06/18/2019 TO 06/18/2020
First Named Insured: MARY COONEY
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 04 85 08 18, CIT 23 94 02 16, CIT 24 07 08, CIT 04 86 08 18, CIT HO -3 02 19
Rating/Underwriting Information
Year Built:
1951
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:
B
Wind / Hail Exclusion:
No
Roof Cover:
Non-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 A
Use:
Primary
Roof -Wall Connection:
Toe Nail
Number of Families:
1
Secondary Water Resistance:
No
Protection Class:
2
Roof Shape:
Hip
Distance to Hydrant (ft.):
250
Opening Protection:
None
Distance to Fire Station (mi.):
2
A premium adjustment of ($666) 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 $39. Of this amount:
The premium difference due to an approved rate change is $0
The premium difference due to changes in your coverage is $37
The premium difference due to mandatory additional charges plus FHCF Build-up is $2
I DEC H03 01 19
Mortgageholder
Page 2 of 5
fCmzENs
PIMPHIY INSURANCE: CORRCIR.A ::N
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Homeowners HO -3 Special Form Policy - Declarations
Policy Number: 00674216 - 5 POLICY PERIOD: FROM 06/18/2019 TO 06/18/2020
First Named Insured: MARY COONEY at 12:01 a.m. Eastern Time at the Location of the Residence Premises
ADDITIONAL NAMED INSURED(S)
Name
Address
No Additional Named Insureds
# Interest Type
ADDITIONAL INTEREST(S)
Name and Address
Loan Number
1 1st Mortgagee
CITIMORTGAGE INC ISAOA
PO BOX 7706 SPRINGFIELD, OH 45501-7706
0577719582
2 2nd Mortgagee
City of Clearwater ISAOA ATIMA
112 S OSCEOLA AVE CLEARWATER, FL 33756-5106
00088740000945000403
!DEC H03 01 19
Mortgageholder
Page 3 of 5
CIT1ZENS
P!i{)KEPt tNit;WCI CUKYCIKli N)N
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Homeowners HO -3 Special Form Policy - Declarations
Policy Number: 00674216 - 5 POLICY PERIOD: FROM 06/18/2019 TO 06/18/2020
First Named Insured: MARY COONEY 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.
LAW AND ORDINANCE: LAW AND ORDINANCE
COVERAGE IS AN IMPORTANT COVERAGE
THAT YOU MAY WISH TO PURCHASE. PLEASE
DISCUSS WITH YOUR INSURANCE AGENT.
FLOOD INSURANCE: YOU MAY ALSO NEED TO
CONSIDER THE PURCHASE OF FLOOD INSURANCE.
YOUR HOMEOWNER'S INSURANCE POLICY DOES
NOT INCLUDE COVERAGE FOR DAMAGE RESULTING
FROM FLOOD EVEN IF HURRICANE WINDS AND RAIN
CAUSED THE FLOOD TO OCCUR. WITHOUT SEPARATE
FLOOD INSURANCE COVERAGE, YOU MAY HAVE
UNCOVERED LOSSES CAUSED BY FLOOD. PLEASE
DISCUSS THE NEED TO PURCHASE SEPARATE FLOOD
INSURANCE COVERAGE 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.
I DEC HO3 01 19
Mortgageholder
Page 4of51
CITIZEN
S
' )N3iEi3Y lNi3;'N�CE:<'6FE¢) A 11:N
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
Homeowners HO -3 Special Form Policy - Declarations
Policy Number: 00674216 - 5 POLICY PERIOD: FROM 06/18/2019 TO 06/18/2020
First Named Insured: MARY COONEY at 12:01 a.m. Eastern Time at the Location of the Residence Premises
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.
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.
IDEC H03 01 19
Mortgageholder
Page 5 of 5
00088740000945080404
945
DAVID TAPIA
DAVID TAPIA INSURANCE AGENCY INC.
133 N GARDEN AVE
CLEARWATER, FL 33755
CITY OF CLEARWATER ISAOA ATI MA
112 S OSCEOLA AVE
CLEARWATER, FL 33756-5106
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