POLICY CHANGE SUMMARY - HOMEOWNERS HO-3 SPECIAL FORM POLICY - DECLARATIONS (3)iror
CITIZENS
P4OPEliFf I ttaAkCI cr POYAI ON
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY ST
JACKSONVILLE FL 32202
POLICY CHANGE SUMMARY
POLICY NUMBER: 01534754 - 5
POLICY PERIOD FROM 12/19/2019 TO 12/19/2020
at 12:01 a.m. Eastern Time
Transaction: RENEWAL
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Dwelling at 406 LEBEAU ST, CLEARWATER, FL
Dwelling Coverages
Coverage A
Coverage A - Dwelling
202,500
206,300
Coverage B
Coverage B - Other Structures Amount
4,050
4,130
Coverage C
Coverage C - Personal Property
Line Coverages.;
50,630
51,580
Coverage D
Coverage D - Loss of Use
20,250
20,630
Hurricane
Hurricane - Deductible Amount
10,125
10,315
Ordinance Or Law
Ordinance Or Law - Amount
50,630
51,580
Sinkhole
Sinkhole - Deductible Amount
20,250
20,630
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
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CITIZENS
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY STREET, SUITE 1300
JACKSONVILLE FL 32202-5142
Homeowners HO -3 Special Form Policy - Declarations
POLICY NUMBER: 01534754 - 5
POLICY PERIOD: FROM 12/19/2019 TO 12/19/2020
at 12:01 a.m. Eastern Time at the Location of the Residence Premises
Transaction: RENEWAL
Named Insured and Mailing Address:
First Named Insured:
BARBARA SANTIN
406 LEBEAU ST.
CLEARWATER, FL 33755
Phone Number: 727-441-1323
Location Of Residence Premises:
406 LEBEAU ST
CLEARWATER FL 33755
County:PINELLAS
Agent: FI. Agent Lic. #: A259595
Fox Agency, Inc.
Stephen Szafranski
1955 DREW ST
Clearwater, FL 33765
Phone Number: 727-447-8585
Citizens Agency ID#: 3092
Primary Email Address: No Email Address
On File
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
Sinkhole Loss Deductible: $20,630 (10%)
SECTION I - PROPERTY COVERAGES
A. Dwelling :
B. Other Structures:
C. Personal Property:
D. Loss of Use:
SECTION 1I - 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 Bulid-Up Premium:
Premium Adjustment Due To Allowable Rate Change:
Hurricane Deductible: $10,315 (5%)
LIMIT OF LIABILITY ANNUAL PREMIUM
$1,391
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 $1,027
Authorized By: Stephen Szafranski
$206,300
$4,130
$51,580
$20,630
$100,000
$2,000
(See Policy)
(See Policy)
SUBTOTAL:
Non -Hurricane Coverage is $657
$6
INCLUDED
Included
$216
$1,613
$71
$0
$2
$29
$1,715
Processed Date: 10/29/2019
DEC H03 12 19
Mortgageholder
Page 1 of 5
00001791001691000402
I!ITIZENS
40PEFiY tu51.14R1tCE COtiYi1 AIR1r
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY STREET, SUITE 1300
JACKSONVILLE FL 32202-5142
Homeowners HO -3 Special Form Policy - Declarations
Policy Number: 01534754 - 5 POLICY PERIOD: FROM 12/19/2019 TO 12/19/2020
First Named Insured: BARBARA SANTIN at 12:01 a.m. Eastern Time at the Location of the Residence Premises
Forms and Endorsements applicable to this policy:
CIT HO -3 02 19, CIT 24 07 08, CIT 23 94 02 16, CIT 04 86 08 18, CIT 04 85 08 18, CIT 04 96 02 16
Rating/Underwriting Information
Year Built:
1946
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:
C
Wind / Hall 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:
Toe Nail
Number of Families:
1
Secondary Water Resistance:
No
Protection Class:
2
Roof Shape:
Gable
Distance to Hydrant (ft.):
100
Opening Protection:
None
Distance to Fire Station (ml.):
2
A premium adjustment of ($175) 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 $129. Of this amount:
The premium difference due to an approved rate change is $105
The premium difference due to changes in your coverage is $26
The premium difference due to mandatory additional charges plus FHCF Build-up is ($2)
DEC H03 12 19
Mortgageholder
Page 2 of 5
I!ITIZENS
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY STREET, SUITE 1300
JACKSONVILLE FL 32202-5142
Homeowners HO -3 Special Form Policy - Declarations
Policy Number: 01534754 - 5 POLICY PERIOD: FROM 12/19/2019 TO 12/19/2020
First Named Insured: BARBARA SANTIN at 12:01 a.m. Eastern Time at the Location of the Residence Premises
ADDITIONAL NAMED INSURED(S)
Name
Address
No Additional Named Insureds
ADDITIONAL INTEREST(S)
# Interest Type
Name and Address
1 1st Mortgagee
CITY OF CLEARWATER ISAOA ATIMA
Loan Number
112 S OSCEOLA AVE CLEARWATER, FL 33756-5106
RL1348-1409
2 2nd Mortgagee
CITY OF CLEARWATER HOUSING DIV ISAOA ATIMA
112 S OSCEOLA AVE CLEARWATER, FL 33756-5106
RI 1348-1409
DEC H03 12 19
Mortgageholder
Page 3 of 5
00001791001691000403
<---VZITIZENS
Y.i',WEF�YP U Aki'E CCIPO4AT:O!
CITIZENS PROPERTY INSURANCE CORPORATION ,
301 W BAY STREET, SUITE 1300
JACKSONVILLE FL 32202-5142
Homeowners HO -3 Special Form Policy - Declarations
Policy Number: 01534754 - 5 POLICY PERIOD: FROM 12/19/2019 TO 12/19/2020
First Named Insured: BARBARA SANTIN 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: 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.
DEC H03 12 19
Mortgageholder
Page 4 of 5
(ITIZE N S
Policy Number: 01534754 - 5
t\1._ „ LL i
CITIZENS PROPERTY INSURANCE CORPORATION
301 W BAY STREET, SUITE 1300
JACKSONVILLE FL 32202-5142
C-FFICIAI RECORDS AN'
Homeowners HKaipecia1 Form - Declarations
POLICY PERIOD: FROM 12/19/2019 TO 12/19/2020
First Named insured: BARBARA SANTIN 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.
DEC H03 12 19
Mortgageholder
Page 5 of 5
00001791001691080404