Heritage Property and Casualty 

Insurance Company

Homeowners Declarations Page 

If you have any questions regarding this policy 

which your agent is unable to answer, please 

contact us at 1-855-620-9978.

Agency Code: H1363

Heritage Property and Casualty Insurance 

Company

2600 McCormick Dr., Ste 300

Clearwater, FL 33759 Agent Name: Insurance Exchange of America LLC

Address: 19670 NW 27th Ave

Miami Gardens, FL 33056

Agent Phone: 8773736073

Policy Number: HPH041169

Named Insured:

Effective Dates: Effective date of this transaction: 9/22/2016 12:01am

Insuring Company:

Mailing Address:

From: 09/22/2016 12:01 am To: 9/22/2017 12:01 am 

Phone Number:

Heritage Property and Casualty Insurance Company

2600 McCormick Dr., Ste 300

Clearwater, FL 33759

Joan Riley

761 NW 45TH AVE

FORT LAUDERDALE, FL 33317

(954) 554-9033

Activity: Renewal

Coverage Section Limits Non-Hurricane Hurricane Total

A. Dwelling *320,289 1702.00 3796.00 5498.00

B. Other Structures -74.00 -165.00 -239.00

C. Personal Property 80,073 -56.00 -89.00 -145.00

D. Loss of Use 32,029 Included

E. Personal Liability 100,000 Included

F. Medical Payments to Others 2,000 Included

Policy Fee 25.00 25.00

Emergency Management Preparedness and 2.00 2.00

Assistance Trust Fund Fee

* Coverage A Increased due to an Inflation Factor

Insured Location:

Coverages & 

Premiums:

Coverage at the residence premises is provided only where a limit of liability is shown or a premium is stated.

Co-Applicant

761 Nw 45Th Ave

Fort Lauderdale, FL 33317

Broward County

Total Policy Premium: $6,750

SEE PAGE 3 FOR DETAILED DESCRIPTION OF PREMIUM ADJUSTMENTS

Total of Premium Adjustments: 537.00 1072.00 1609.00 

All Other Perils: Hurricane Deductible: Deductible:

Special Messages:

$2,500

THIS POLICY CONTAINS A SEPARATE DEDUCTIBLE 

FOR HURRICANE LOSSES, WHICH MAY RESULT IN 

HIGH OUT-OF-POCKET EXPENSES TO YOU.

2% =

Law and Ordinance: Law and Ordinance = $

If your policy contains replacement cost on dwelling, the amount of coverage will not 

exceed the stated policy value.

80,072

$6,406

Ernie Garateix

Authorized Signature

07/24/2016

Page 1 of 3 HPCHO3 DEC2 09 13

Case 1:22-cv-22893-RNS Document 1-1 Entered on FLSD Docket 09/09/2022 Page 1 of 4
Forms

and

Endorsements:

HPC 04 12 07 12

HPC HDR 01 13

HPCHO3 PPS 08 13C

HPC 09 IDT 12 13

HPC CGCC 07 12

HO 04 96 04 91

HPC OLN 07 12

HPC SLC-R 07 12

HPC 24 07 12

HPC WE 07 12

HPC 23 70 07 12

HPC 19 07 12

HPC HO-3 09 13

OIR B1 1670 01 06

OIR B1 1655 02 10

HPC SHOJ 02 14

HPC CE 07 12

HPC PRI 07 12

OC HPC HO-3 07 12

HPC DO 07 12

Any person who knowingly and with intent to injure, defraud or deceive any insurer files a 

statement or an application containing false, incomplete or misleading information is guilty of a 

felony in the third degree.

Number of Payments: 1

HT3

037 1968

Pay Plan:

Rating

Bill to:

Program:

Information: Territory: Year Constructed:

Construction Type: Masonry

MORTGAGEE

Scheduled Property: Description:

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, 

Y O U M A Y H A V E U N C O V E R E D L O S S E S . P L E A S E 

D I S C U S S T H E S E C O V E R A G E S W I T H Y O U R 

INSURANCE AGENT.

In the event of a claim, please call toll free 1-855-415-7120.

We are available 24 hours a day, 7 days a week.

This replaces all previously issued policy declarations, if any. This policy applies only to accidents, occurrences or losses which 

happen during the policy period shown above. In case of property loss, only that part of loss over stated deductibles applies. If 

payment is not received on or before the policy effective date, this policy will no longer be in force. This declaration page together 

with all policy provisions and any other applicable endorsements completes your policy. 

A rate adjustment of 0 % is included to reflect the Building Code Enforcement Grade in your area. Adjustments range from 5 % 

surcharge to 46 % credit.

A rate adjustment of 0 % credit is included to reflect the Windstorm Mitigation Device Credit. This credit applies only to the wind 

portion of your premium. Adjustments range from 0 % to 90 %.

On Property Coverage limit increased at renewal due to an inflation factor of 4%, as determined by a national index of 

construction costs to maintain insurance to the approximate replacement cost of your home.

This policy does not protect you against loss due to flood. Flood insurance is available through the Federal Government. 

Contact your agent to apply for coverage.

Page 2 of 3 HPCHO3 DEC2 09 13

Case 1:22-cv-22893-RNS Document 1-1 Entered on FLSD Docket 09/09/2022 Page 2 of 4
Base Rate 1140.00 1387.00 2527.00

Territory -649.00 -352.00 -1001.00

Increase Deductibles (NHR/HUR) -391.00 -879.00 -1270.00

Ordinance or Law 80072 Included

Loss Assessment Coverage 1000 Included

Limited Fungi, Wet/Dry Rot, Yeast/Bacteria - Sect. 1 10000 Included

Limited Fungi, Wet/Dry Rot, Yeast/Bacteria - Sect. 2 50000 Included

Identity Theft Coverage 25000 25.00 25.00

Age of Dwelling Factor 412.00 916.00 1328.00

Coverage Section Limits Non-Hurricane Hurricane Total

Dollar amount of the premium increase due to coverage changes: 

Dollar amount of the premium increase due to rate increase:

$243.00 

$0.00 

Policy Interest:

NAME ADDRESS INTEREST TYPE BILL TO REFERENCE#

SELECT PORTFOLIO SERVICING 

INC ISAOA

PO BOX 7277

SPRINGFIELD, OH 45501-7277

MORTGAGEE YES 0014832265

Page 3 of 3 HPCHO3 DEC2 09 13

Case 1:22-cv-22893-RNS Document 1-1 Entered on FLSD Docket 09/09/2022 Page 3 of 4