FRJH5932523-01-0000
Homeowners Application
Service Company: APPLICANT create: Citizens
Agents Name: Agency Name: point: Agents FL Ins. Lic. #:
EDEL E MATA, YAMEL D SANTANA 11664 NW 90TH AVE mail Address: HIALEAH GARDENS, FL 33018-4156 FL County: MIAMI-DADE Phone: (786) 399-3973
(where property is located)
ANGELA Gonzalez chromatic INSURANCE, LLC. 15476 NW 77 CT #356 MIAMI LAKES , FL 33016
Citizens Producer #: 35677 Indicate if: make Under Construction Est. Completion Date: X
$2,500 5% 10% Ex Wind
AGENCY
A099915
Form (Select One):
property Address (If different than Mailing Address): 11664 NW 90TH AVE HIALEAH GARDENS, FL 33018 LOCATION
FORM / DED.
X
CIT HO-3 Special Form CIT HO-4 tenant CIT HO-6 Condominium Unit Owner
$500 $500
Deductible ($1,000 Standard): Hurricane Deductible (2% Standard):
worm PREM
Is risk eligible for wind only reportage? Windstorm coverage is X Included
Yes X No Excluded
Total Est. Premium
If dwelling does not have a street address, indicate lot, block, addition or section, township, range, town name. OTHER
Occupation of Named Insured(s)
DRIVER; MEDICAL COURIER
Grand Subtotal
Addl Surcharges
$1,342
first Named Insured
$55
Social Security Numbers / D.O.B.
Spouse or second Named Insured
$1,397
593-25-6325 / 08/30/1964
594-02-3450 / 12/01/1969
Loan Number
Type / Name / Address / Zip Code
INTERESTS
1 First Lien / JPMORGAN CHASE depose / 8880 FREEDOM CROSSING TRL, JACKSONVILLE, FL 32256-1215 2 3 4 5 6
1097162893
LIMITS
BASIC COVERAGES A. Dwelling (CIT HO-3 Max. Limit $1,000,000) B. Other Structures C. Personal Property D. Loss of Use E. Personal Liability (Max. Limit $300,000) F. medical checkup Payments
Coverage Limits
$143,500 $14,350 $71,750 $14,350 $300,000 $2,000
Year Built: For Dwelling over 35 years, indicate 1995 X No Update. year update realised: Wiring: No Update. Heating X No Update. roof: X Roof Material: Tile (Update...If you want to master a full essay, order it on our website: Ordercustompaper.com
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