UnderScore Policy Summary Bucket = D Description ......04. Occupancy: Owner occupied Tenant occupied Vacant Seasonal Unable to Determine 05. Commercial construction converted to residential

4/5/2016

(813) 3740150 Ext.

H0258

ACCURATE INSURANCE MART

HERITAGE

1734.00

Agency Info:

Client Name:

Account #:

16-070-000378

HOH221725

Tracking #:

Policy #:

PORT RICHEY, FL 34668

10333 PASTEL LN

ELLIOTT GARCIAInsured:

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Endorsement / Rating IssueDBucket =

Description =

Form Question # Form Value Client Value Reason

UnderScore Policy Summary

BucketForm_52680 60 TRUE TRUE House Keeping D

YOU AGREE THAT YOUR REQUEST FOR THIS REPORT IS PERMITTED BY LAW AND THAT YOU INTEND TO USE THE REPORT ONLY FOR A PURPOSE PERMITTED BY THE FAIR CREDIT

REPORTING ACT AND LOCAL LAW AND NO OTHER PURPOSE. THIS REPORT IS BASED ON OBSERVATION AND INFORMATION PROVIDED TO US. FOR THE FEE CHARGED, WE DO NOT

ASSUME ANY LIABILITY ARISING OUT OF THE USE OR MISUSE OF THIS REOIRT BY YOU OR OTHERS. YOU AND ANY OTHER USER AGREE TO HOLD US FREE FROM ANY LIABILITY.

(C) Copyright 2007 - National Risk Services, Inc.

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Po

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Agency:

Agency Phone:

Client:

Tracking Number:

Policy Number:

PORT RICHEY, FL 34668

10333 PASTEL LN


(813) 3740150 Ext.

HERITAGE

16-070-000378

HOH221725

35. There is an enclosed in-ground pool on the rear side.

60. There are broken cinder blocks on the left side.

There was no full access to the rear side due to secured gates, the rear and pool photos were taken over the left side fence.

YOU AGREE THAT YOUR REQUEST FOR THIS REPORT IS PERMITTED BY LAW AND THAT YOU INTEND TO USE THE REPORT ONLY FOR A PURPOSE PERMITTED BY THE FAIR CREDIT

REPORTING ACT AND LOCAL LAW AND NO OTHER PURPOSE. THIS REPORT IS BASED ON OBSERVATION AND INFORMATION PROVIDED TO US. FOR THE FEE CHARGED, WE DO NOT

ASSUME ANY LIABILITY ARISING OUT OF THE USE OR MISUSE OF THIS REOIRT BY YOU OR OTHERS. YOU AND ANY OTHER USER AGREE TO HOLD US FREE FROM ANY LIABILITY.

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16-070-000378Dwelling Observation Survey (52680 DOS-04)

1734.00

Insured: ELLIOTT GARCIALocation: 10333 PASTEL LN

City: PORT RICHEY State: FL Zip: 34668 Coverage Amount: 150000.0000

Policy #: HOH221725Company: HERITAGE

Agent: ACCURATE INSURANCE MARTAgent Phone: (813) 3740150

Year Built: 1973 Sq Footage: 1405

Acct: Date: 0 3 / 3 0 / 2 0 1 6

DWELLING DESCRIPTION 01. Interview obtained. If so, whom?: 02. Unable to confirm address 03. Type of dwelling: More than 4 family 4 family 3 family 2 family 1 family 04. Occupancy: Owner occupied Tenant occupied Vacant Seasonal Unable to Determine 05. Commercial construction converted to residential Evidence of student housing Converted from single-family to multi-family 06. Non-traditional construction: A-frame construction Geodesic dome Earthen home Straw / Hay HUD tagged home Log home 07. Number of stories: (Check only one.) Other: Tri-level Bi-level 4 3 2 1

1 9 7 3 08. Year built: Tax record Estimated Per interview 09. Primary foundation: (Check only one.) Pier & Post Crawl Space Slab Basement

Description of other: 10. Construction: Frame: % Masonry veneer: 1 5 % Masonry: 8 5 % Other: % 11. Primary roof covering: (Check only one.) Other Tar & gravel Concrete Metal Tile Wood Asbestos shingle Composition 12. Primary roof type: (Check only one.) Other: Flat Mansard Gambrel Hip Gable

13. Estimated roof life remaining: Less than 5 years 5 to 10 years More than 10 years

DWELLING CONCERNSPaint chipping / peeling 14.Exterior wall / siding concerns 15.Foundation concerns 16.Open foundation 17.

18. Elevated surface concern: (Porches, decks, balconies, etc. Check all that apply.) Broken railing(s) In need of repair 18A. If missing railing(s), inches above ground: (Check all that apply.) 12" - 24" 25" - 35" 36" - 72" > 72" 19. Step problem(s): Steps in need of repair Broken handrail(s) Missing handrail(s): (Check all that apply.) 3 steps 4 steps 5 or more steps 20. Suspicion of synthetic stucco (EIFS) 21. Suspicion of asbestos siding 22. Gutter concerns 23. Renovations underway 24. Broken window(s) 25. Boarded window(s) 26. Roof in need of repair 27. Solid fuel device 28. Evaporative cooler on the roof 29. Wood shake siding

PREMISE CONCERNS 30. Evidence of dog(s) (not observed): (Check all that apply.) "Beware of Dog" sign noted Heard barking from inside house Dog house on premises 31. Dog(s) observed: Dog 1: Aggressive or vicious Bite history Predominant breed:

Dog 2: Aggressive or vicious Bite history Predominant breed:Dog 3: Aggressive or vicious Bite history Predominant breed:

32. Metal security bars on window(s) No quick releases evident 33. Outbuilding(s) on premises: (Check all that apply.) Need(s) paint Need(s) repair 400 - 599 sq ft 600 - 799 sq ft 800 sq ft or larger 34. Business on premises Type: Signage Employees Customer traffic

51. Heating oil tank(s) Underground

35. SlideSwimming pool(s): (Check all that apply.) Unfenced Non-latching gate In-ground Diving board 36. Un-nettedTrampoline(s): (Check all that apply.) Unfenced 37. Unfenced UncoveredHot tub or spa: (Check all that apply.) 38. Retaining wall In need of repair A. Check all that apply. Height: < 4' 4-6' > 6' Length: < 10' 10-20' > 20' B. Est. length (ft): 39. Height above water: (In feet.) Lake/pond within 1,000 feet Distance from water: (In feet.) 40. River/canal within 1 mile Distance from water: (In feet.) Height above water: (In feet.) 41. Ocean/tidewater within 1/2 mile Distance from water: (In feet.) Height above water: (In feet.) 42. Subject to flooding

YOU AGREE THAT YOUR REQUEST FOR THIS REPORT IS PERMITTED BY LAW AND THAT YOU INTEND TO USE THE REPORT ONLY FOR A PURPOSE PERMITTED BY THE FAIR CREDIT REPORTING ACT AND LOCAL LAW AND NO OTHER PURPOSE. THIS REPORT IS BASED ON OBSERVATION AND INFORMATION PROVIDED TO US. FOR THE FEE CHARGED, WE DO NOT ASSUME ANY LIABILITY ARISING OUT OF THE USE OR MISUSE OF THIS REPORT BY YOU OR OTHERS. YOU OR ANY OTHER USER AGREE TO HOLD US FREE FROM ANY LIABILITY.

43. Subject to landslide 44. Hillside / Slope: Degree of slope: 45. Distance:Brush or forest within 300 feet: 0 - 50 ft 51 - 100 ft 101 - 300 ft

46. Farming or ranching 47. Farm animal(s)/livestock 48. Exotic animal(s) 49. Above-ground gasoline

or diesel tank(s) 50. Above-ground LP tank(s)

52. Sidewalk(s) in need of repairSurface elevation change:

< 1" 1" - 3" > 3" 53. Driveway(s) in need of repair

Surface elevation change: < 1" 1" - 3" > 3"

54. Tree limb(s) overhanging roof Limbs diameter < 3" Limbs diameter 3" or more

55. Tree limb(s) touching roof Limbs diameter < 3" Limbs diameter 3" or more

56. Playground equipment

57. Junk car(s) 58. Appliance(s) 59.

Trip or fall hazard(s)Lumber

60. Housekeeping 61. Property for sale 62. Property for rent

63. Chimney concern(s) 64. 65. Lack of landscape maintenance 66. Tree house(s) 67. Exterior electrical concern(s)

PROTECTION 68. Dwelling on unpaved road: Mile(s) from pavement: < 1 1 - 5 > 5 69. Number of other permanent residences within view of dwelling: None 1 - 2 3 - 4 5 - 6 More than 6 70. Dwelling located in secured subdivision. 74A. Secured by: Attended guard house Unattended guard house Keypad and gate only

Historical district

71. If dwelling is located in secured subdivision, single entrance only. 72. Water source: Alternate water (pond, lake) Hydrant None 73. Distance to water source (in feet): > 1,000 ft 501 - 1,000 ft 0 - 500 ft 74. Distance to fire department (in miles): 10 or more mi > 5 and < 10 mi 2 - 5 mi < 2 mi

12A. If the primary roof type is hip, does any other roof type comprise 10% or more of the remaining roof? Yes

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NISN EXTERIOR REPLACEMENT COST WORKSHEET - XactValue

ELLIOTT GARCIAInsured: Policy #:

Tracking #:

HOH221725

First Addition1 9 7 3

Number of Stories:

Calculate functional replacement cost (only applies if Year Built is prior to 1971) Year Built: Square Feet: Year Built:

Style:

Families:

Number of Stories:

4 Level Split

Tri-level

Bi-level

3 Story

2-1/2 Story

2 Story

1-1/2 Story

1 Story

Town/Row House (Interior)

Town/Row House (End)

Conventional

4 3 2 1

3 Story

2-1/2 Story

2 Story

1-1/2 Story

1 Story

Main SectionGENERAL INFORMATION

Second Additionsq ft 1 4 1 4 Total square footage of finished area: Year Built:

Number of Stories:

Square Feet:

3 Story

2-1/2 Story

2 Story

1-1/2 Story

1 Story Include square footage of finished basement, attic, and additions. Do not include unfinished areas. Do not include built-in garage in finished living area.

FOUNDATION Shape:

Foundation Type:

Mark the foundation type for the living area only, not including the garage or carport.

Irregular "Z" Shaped "U" Shaped "T" Shaped "L" Shaped Simple Rectangle

A bi-level home has a lower floor about four feet below grade and a main floor about four feet above grade. This type of home typically has a shallow basement.

A tri-level home has three full floors of living area at three different levels: one usually at grade, one four feet above and one below. The foundation type for the below-grade portion is generally a shallow

Basement:

Percent Finished: % % %1 0 0 % % % %

inches

Shallow Basement:

Concrete Slab:

Crawl Space:

Pier & Grade Beam:

Stilts with Sweep Away Walls:

Elevated Post & Beam (Stilts):

Average Post Height: %

Materials:

Property Slope:

Walkout:

Concrete:

Block:

Wood:

Stone:

Brick:

1 0 0 % % % % %

Steep (>30 deg)

Moderate

None

No Yes

EXTERIOR Roof Type: Number of Dormers: Flat Mansard Gambrel Hip Gable Roof Materials:

Exterior Walls:

Asphalt Shingle (3 tab):

Architectural:

Roll Roofing:

Clay Tile:

Concrete Tile:

Corrugated:

Flat Metal Panel:

Copper:

Aluminum or Metal Siding:

Vinyl Siding:

Brick Veneer:

Stone Veneer:

Synthetic Stucco/Framing:

Synthetic Stucco/Block:

Masonry Stucco/Framing:

Masonry Stucco/Block:

Hardboard / Masonite / Asbestos:

Pine (Beveled / Clapboard):

Cedar (Beveled / Clapboard):

1 Car Garage:

2 Car Garage:

3 Car Garage:

Storage Shed:

% % % %1 0 0 % % % %

Wood:

Slate:

Spray Foam:

Hot Mopped w/ Gravel:

Hot Mopped w/o Gravel:

Rubber Membrane:

Vinyl Membrane:

% % % % % % %

Exterior Features: (Quantity)

Exterior Door:

8-foot Exterior Door:

Arched Top Exterior Door:

Patio Door:

Storm Window:

Bay or Bay Window:

Specialty Window:

Round or Octagonal Window:

Skylight:

Stained Glass Window:

Transom Window:

Exterior Shutter (# Sets):

Motorized Awning:

Brick Column:

Decorative Fiberglass Column:

Attached Garage / Carport

Amount of living space above garage:

Cars:

Style:

% % 1 5 % % % % % 8 5 % % % %

Redwood (Beveled / Clapboard):

Wood Shingle/Shake:

Fiber-Cement Lap Siding:

Log Siding:

T-111 Plywood Siding:

Concrete Block:

Solid Adobe:

Solid Logs:

Solid Concrete:

Solid Brick:

Solid Stone:

% % % % % % % % % % %

2

2 + 1/2

Carport Basement Attached / Built-in

%

Sq Ft:

Sq Ft:

Sq Ft:

Sq Ft:

Material:

First Deck / Balcony

Polymer Cedar Redwood Treated Deck

First Patio / Porch

Sq Ft: 1 0 5 Covered:

Enclosed: %1 0 0 % Treated Decking

Wood Polymer Cedar Decking Redwood Decking

Exposed Aggregate Brick Pavers Colored Concrete Concrete

Material:

Material:

Type:

Sq Ft:

Sq Ft:


Second Deck / Balcony

Third Deck / Balcony

Other

Detached Structures (Quantity)

Air Conditioning

Second Patio / Porch

Third Patio / Porch

Fireplaces


Greenhouse Heated Sunroom

Covered:

Covered:

Enclosed:

Enclosed:

% %

% %

Treated Decking Wood Polymer Cedar Decking Redwood Decking


Treated Decking Wood Polymer Cedar Decking Redwood Decking


Spa / Hot Tub:

Pool:

Pool House:

1

Cabana:

Greenhouse:

Guesthouse:

Small Barn:

Large Barn:

Gazebo:

Heat Pump - Heating/Cooling System

Wall Air Conditioning Unit

Humidifier

Evaporative Cooler

Central Air Conditioning

None None

Zero Clearance Fireplace

Masonry Fireplace

Wood Stove

Fireplace Insert

Beehive Fireplace

L1/S

14'

12'

9'

32'

17'

10'

6'

15'

16'

PC 12'

SPE

30'

20'

AG

5'

21'

20' 15'

SP

21'

Name ELLIOTT GARCIA Reference Number 16-070-000378 Policy Number HOH221725

(C) 2006 - 2014 National Risk Services, Inc.

Area Name Sign Multiplier Perimeter (ft.) Area Value (sq. ft.) Living Area L1/S + 1 194 1414 Summary Living Area 1414 sq.ft. Patio/Deck Area PC + 1 84 360 Summary Patio/Deck Area 360 sq.ft. Porch Area SPE + 1 100 600 SP + 1 52 105 Summary Porch Area 705 sq.ft. Garage Area AG + 1 82 420 Summary Garage Area 420 sq.ft.

Agent Phone:

Agent:

Company:

Pol. #:

Zip:State:City:

Location:

Insured:

Photo Sheet


Photo Description:

Photo Description:

Address

Front

ELLIOTT GARCIA

10333 PASTEL LN

PORT RICHEY FL 34668

HOH221725

HERITAGE


(813) 3740150 Ext.

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Agent Phone:

Agent:

Company:

Pol. #:

Zip:State:City:

Location:

Insured:

Photo Sheet


Photo Description:

Photo Description:

Rear

Left

ELLIOTT GARCIA

10333 PASTEL LN


HOH221725

HERITAGE


(813) 3740150 Ext.

tdemeza

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Agent Phone:

Agent:

Company:

Pol. #:

Zip:State:City:

Location:

Insured:

Photo Sheet


Photo Description:

Photo Description:

Right

Right-2

ELLIOTT GARCIA

10333 PASTEL LN


HOH221725

HERITAGE


(813) 3740150 Ext.

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Agent Phone:

Agent:

Company:

Pol. #:

Zip:State:City:

Location:

Insured:

Photo Sheet


Photo Description:

Photo Description:

Outbuilding

Pool

ELLIOTT GARCIA

10333 PASTEL LN


HOH221725

HERITAGE


(813) 3740150 Ext.

tdemeza

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Agent Phone:

Agent:

Company:

Pol. #:

Zip:State:City:

Location:

Insured:

Photo Sheet


Photo Description:

Photo Description:

Clutter

Limited access

ELLIOTT GARCIA

10333 PASTEL LN


HOH221725

HERITAGE


(813) 3740150 Ext.

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Documents

UnderScore Policy Summary Bucket = D Description ......04. Occupancy: Owner occupied Tenant occupied Vacant Seasonal Unable to Determine 05. Commercial construction converted to residential