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SizemoreLexisNexis is not the Insurance Company. For any and all policy changes you must contact the Insurance Company, the Carrier or the Producer listed in the detail below. If you are not the intended recipient, please return this card. Place Stamp Here 1136649 - 8610340 -1 -M LexisNexis /FIRSt 2885 Breckinridge Blvd, Ste 400 Duluth, GA 30096 IMPORTANT: INSURANCE COVERAGE NOTIFICATION(S) LexisNexis is not the Insurance Company. Do not send premium payments to LexisNexis /FIRSt. -For any and all policy changes you must contact the Insurance Company, Carrier, or Producer listed in the detail below. -For all cancellation, non - renewal, expiration, and lapse notices -all coverage will cease at 12:01 AM local time at the premises, unless otherwise shown in the item detail provided. -If you want to receive future notifications electronically, email firstsupport @lexisnexis.com. -This Insurance notice is sent to you as the Loss Payee /Mortgagee /Additional Interested Party on behalf of the carrier listed. Policy: HSV002077801 REASON: Intent to Cancel Policy Eff. Dte: 11/04/2015 12:01 AM ST Pol. Type:Homeowners Pol. From: 11/04/2015Pol. To: 11/04/2016 Carrier: SOUTHERN FIDELITY INSURANCE Prop. Loc: 203 SW 21ST STREET - OKEECHOBEE -FL 34974 Loan #: End.NojState: SFHFLHD -FL I SFHFLH3-FL I SFHFLD3-FL I HO- 0496 -FL l SFHFLLA -FL Insured: EDWARD J SIZEMORE -PO BOX 9- PEMBROKE -VA -24136 Mortgagee /Add.Party: CITY OF OKEECHOBEE -55 SE 3RD AVENUE - OKEECHOBEE -FL -34974 Insurance: SOUTHERN FIDELITY INSURANCE -PO BOX 16029- Tallahassee -FL -32317 Producer: BERGER INSURANCE ASSOC LLC -425 SW STREET - OKEECHOBEE FL-FL-34974863.763.6411 Coverage Coverage Amt/Deduct Coverage Coverage AmVDeduct PremiumAmount: 4,172.00 Dwelling 306,000/500 Other Structures 30,600/500 Total PolicyPremium:4,172.00 Personal Property 153,000/500 Loss of Use 61,200/0 Liability 300,000/0 Med Pay 1,000/0 Earthquake EXCL Wind & Hail 306,000/6,120 Sinkhole Coverage EXCL Flood EXCL Notes: FORMS SCHEDULE SFHFLME SFHFLPC SFHFLHJ SFHFLPN SFHFLOL HO -0490 SFHFLSC SFHFLCGCC SFHFLMC3 SFHFLRL3 HO 0355 110 -0109 SFHFLIT 01RB11655 01RB11670 FIRSt Id: 10136 -I166- 8610340- 283670918 HOMEOWNER DECLARATION P.O. Box 16029 Tallahassee FL 32317 -6029 Southern Fidelity Insurance Company 11/04/2014 11/04/2015 12:01 A.M. Standard Time a the described location NEW DECLARATION EDWARD J SIZEMORE 203 SW 21ST STREET OKEECHOBEE FL 34974- Telephone: 863-467-8178 Effective: 11/04/2014 ate Issued: 09/05/2014 BERGER INSURANCE SOC, LLC DBABERGER INSURAN E SERVICES 800S PAR R OTT AVE OKEECHOBEE, FL 349 4 Telephone: 863.763 -6411 The residence premises covered by this policy is located at the above insured address unlefis otherwise stated below 203 SW 21ST STREET OKEECHOBEE FL 34974 All other perils deductible: $ 500.00 Premium: Hurricane Deductible: $ 6,120.00 Note: The portion of your premium for Hurricane Coverage is: SECTION I, SECTION II AND OPTIONAL PRE IUMS EMERGENCY MANAGEMENT TRUST FUND SURC RGE MGA POLIO FEE 2012 FLORIDA INSURANCE GUARANTY FUND ASSESSMENT FLORIDA HURRICANE CATASTROPHE FUND CITIZENS EMERGENCY HRA ASSES MENT 4,783.00 $ 2,144.00 $ 4,647.00 $ 2 $ 4 6 2 3 0 6 .00 .00 .00 .00 .00 TOTAL POLICY PREMIUM INCLUDING ASSESSMENTS AND ALL SURC -RGES FORM TYPE H0 -3 CONSTRUCT TYPE M TERRITORY 555 USE CODE P COUNTY CODE 047 PROT DEV /SPRINKLER N REPLACEMENT COST Y YEAR BUILT CONSTRUCT SUPERIOR PROTECTION CLASS HOME UPDATED PROT DEVICE/BURGLAR EXCLUDE CONTENTS OCCUPANCY CODE 1965 N 03 N N N OWNER 4,783.00 TOWN/ROW HOUSE NUMBER OF FAMILIE PRIOR DEC S/C MUNICIPAL CODE PROT DEVICE/FIRE WINDMAIL EXCLUSIO THIS POLICY CONTAINS A SEPARATE DE ' UCTIBLE FOR HURRICANE LOSSES, WHICH MAY RESULT IN HIGH OUT -OF- POCKET EXPENSES TO YOU. INSURED'S COPY 1 N 999 N N TOTAL WIND MITIGATION CREDITS ROOF COVER FBC EQUIVALENT ROOF DECK 6d @ 6/12 ROOF SHAPE OTHER ROOF SHAPE - GABLE/FLAT ROOF WALL TOE NAILS OPEN PROTECTION NONE SWR NO SWR TERRAIN TERRAIN B 2 %DED FBC WIND SPEED MPH N/A WIND SPEED OF DESIGN N/A INTERNAL PRESSURE N/A WBDR N/A *SFHFLD3 (04/05) * SFHFLLA (04/05) *SFHFLPN (04/05) *SFHFLHD (04/05) *SFHFLMC3 (04/05) *SFHFLSC 104/05) HSV 0020778 00 FORMS SCHEDULE (continued from page 1) *SFHFLHJ (04/05) *SFHFLME (04/05) *SFHFLWL (04/09) * SFHFLH3 * SFHFLOL 11/04/2014 12:01 A.M. Standard Time a 11/04/2015 the described location (08/08) (04/05) YOUR POLICY PROVIDES COVERAGE FOR CATAST GROUND COVER COLLAPSE THAT RESULTS IN THE PR BEING CONDEMNED AND UNINHABITABLE. THERWISE POLICY DOES NOT PROVIDE COVERAG FOR SI LOSSES. YOU MAY PURCHASE ADDITIONAL COVERA SINKHOLE LOSSES FOR AN ADDITIONAL PRE IUM. LAW AND ORDINANCE COVERAGE IS COVERAGE THAT YOU MAY WISH TO PUR ALSO NEED TO CONSIDER THE PURC INSURANCE FROM THE NATIONAL FL PROGRAM. WITHOUT THIS COVERAGE, UNCOVERED LOSSES. PLEASE DISCUSS TI WITH YOUR INSURANCE AGENT. SFIC FL FS 09/02 INSURED'S COPY AN IMP HASE. YO ASE OF OD INSU OU MAY ESE COV OPHIC PERTY YOUR KHOLE E FOR RTANT MAY FLOOD NCE HAVE RAGES LexisNexis is not the Insurance Company. For any and all policy changes you must contact the Insurance Company, the Carrier or the Producer listed in the detail below. If you are not the intended recipient, please return this card. IMPORTANT: INSURANCE COVERAGE NOTIFICATION(S) LexisNexis is not the Insurance Company. Do not send premium payments to LexisNexis /FIRSt. 986335- 8610340 -1 -M LexisNexis /FIRSt Mail Drop B1/250 -W 1000 Alderman Dr Alpharetta, GA 30005 RECEIVED 341 Place Stamp Here 5 2014 -For any and all policy changes you must contact the Insurance Company, Carrier, or Producer listed in the detail below. -For all cancellation, non - renewal, expiration, and lapse notices -all coverage will cease at 12:O1AM local time at the premises, unless otherwise shown in the item detail provided. -If you want to receive future notifications electronically, email firstsupport@lexisnexis.com. -This Insurance notice is sent to you as the Loss Payee /Mortgagee /Additional Interested Party on behalf of the carrier listed. Policy: SH0103067505 REASON: Policy Change Eff. Dte: 11/04/2013 Pol. Type:Homeowners Pol. From: 11/04/2013Po1. To: 11/04/2014 Carrier: SOUTHERN FIDELITY INSURANCE Loan #: Prop. Loc: 203 SW 21ST STREET - OKEECHOBEE -FL 34974 End.No. /State: SFHFLHD -FL 1 SFHFLH3 -FL 1 SFHFLD3-FL 1 HO- 0496 -FL 1 SFHFLLA -FL Insured: EDWARD J SIZEMORE -203 SW 21ST STREET - OKEECHOBEE -FL -34974 Mortgagee /Add.Party: CITY OF OKEECHOBEE -55 SE 3RD AVENUE - OKEECHOBEE -FL -34974 Insurance: SOUTHERN FIDELITY INSURANCE -PO BOX 16029 - Tallahassee -FL -32317 Producer: BERGER INSURANCE ASSOC LLC -800 S PARROTT AVE- OKEECHOBEE FL -FL -34974 863.763.6411 Coverage Coverage Amt/Deduct Coveraae Coveraae Amt/Deduct PremiumAmount: 0.00 Dwelling 306,000/500 Other Structures 30,600/500 Total Policy Premium:4,776.00 Personal Property 153,000/500 Loss of Use 61,200/0 Liability 300,000/0 Med Pay 1,000/0 Earthquake EXCL Wind & Hail 306,000/6,120 Sinkhole Coverage 306,000/500 Flood EXCL Notes: FORMS SCHEDULE SFHFLME SFHFLPC SFHFLHJ SFHFLPN SFHFLOL 50 -0990 SFHFLSC SFHFLLL SFHFLMC3 SFHFLRL3 HO 0355 H0 -0109 SFHFLIT OIRB11655 OIRB11670 FIRSt Id: 10136 -I166- 8610340- 290266633 LETTER OF UNDERSTANDING THIS AGREEMENT, BY AND BETWEEN THE CITY OF OKEECHOBEE, FLORIDA, a Florida municipal corporation (hereinafter "CITY ") and Edward J. Sizemore antificancesdixersort, xPligRifeTiftWWW6 (hereinafter "OWNERS "), dated this £iyk. day of Thal _ , 1999. unremarried widower 0 WHEREAS, OWNERS hold fee simple title to the following described real property in Okeechobee County, Florida, to wit: Lots 1, 2, 3 and 4, Block 45, FIRST ADDITION TO SOUTH OKEECHOBEE, according to the plat thereof recorded in Plat Book 1, Page 17, Public Records of Okeechobee County, Florida; and WHEREAS, the OWNERS desire to make certain improvements in the form of a driveway located across a 15 feet alley right -of -way which runs North to South between Lots 1 to 8 of said Block 45, which is owned by the CITY, and NOW, 'THEREFORE, in consideration of the mutual promises and covenants set forth herein, the parties agree as follows: 1. The CITY hereby grants its approval for use of the alley right -of -way with the understanding the OWNERS will maintain the alley right -of -way and should it ever become necessary to remove the driveway and /or culverts or any improvement thereon, in order to allow either the installation, or maintenance of water, sewer, or other utility lines or any other type of installation or construction, or for any other reason chosen by the CITY, the driveway and /or culvert, or any improvement thereon, will be removed by the OWNERS or their agents and/or assigns at the OWNERS expense within seven days of receipt of written request by the CITY for such removal. Should the CITY, for valid reasons, require the removal of the driveway and /or culvert, or any improvements thereon less than seven days notice, the OWNERS agrees to exercise reasonable efforts to comply with such requests. 2. OWNERS agree to contact their insurance company and require a rider be added to their insurance policy with a certificate furnished to the CITY showing the 15 feet alley right -of -way as herein described to be used by them insures the CITY against any liability arising out of alleged injuries or other activities which may occur within the 15 feet alley right -of -way. In any event, OWNERS agree and shall hold the CITY harmless for any and all action, suit, claim, injury or cause of action of any nature arising out of this permissive use, and indemnify CITY for such, including costs and attorney fees. IN WITNESS WHEREOF, the parties hereto set their hands and seals on the aforesaid date. Signel, sealed and delivered in presence of: Witness N/A Witness Accepted for the City: 44L(7-1 Director of Public Works Reviewed for Legal Sufficiency: John R. Cook, City Attorney !. Edward J. Size N/A ore Frances Sizemore ATTEST: Bonnie S. Thomas, C IC, City Clerk Accepted for the .`(2.i:y-: ' Robert J. Bradshaw, City Administrator HOMEOWNERS DECLARATION i _ SFIC P.O. Box 16029 Tallahassee FL 32317-6029 Southern Fidelity Insurance Company POLICY NUMBER POLICY PERIOD From To SHO 1030675 05 69 11/04/2013 11/04/2014 12:01 A.M. Standard Time at the described location For Customer Service and Claims Call 1- 866 - 874 -7342. RENEWAL DECLARATION Effective: 11/04/2013 Date Issued: 09/10/2013 INSURED: AGENT: 0901140 EDWARD J SIZEMORE BERGER INSURANCE ASSOC, LLC 203 SW 21ST STREET DBA BERGER INSURANCE SERVICES OKEECHOBEE FL 34974- 800 S PARROTT AVE OKEECHOBEE, FL 34974 Telephone: 863 - 467 -8178 Telephone: 863 - 763 -6411 The residence premises covered by this policy is located at the above insured address unless otherwise stated below: 203 SW 21ST STREET OKEECHOBEE FL 34974- IF PAYMENT IS NOT RECEIVED ON OR BEFORE THE POLICY RENEWAL EFFECTIVE DATE, THIS POLICY WILL NOT BE IN FORCE. Coverage is provided where premium and limit of liability is shown. Flood coverage is not provided by SOUTHERN FIDELITY and is not a part of this policy. SECTION I COVERAGE A. DWELLING B. OTHER STRUCTURES C. PERSONAL PROPERTY D. LOSS OF USE SECTION II COVERAGE E. PERSONAL LIABILITY $300,000.00 F. MEDICAL PAYMENTS $1,000.00 OPTIONAL COVERAGES Replacement Cost Contents LIMITED FUNGI,ROT BACTERIA $10, 000/$20, 000 LIMIT OF LIABILITY $306,000.00 $30,600.00 $153,000.00 $61,200.00 EQUIPMENT BREAKDOWN ENHC ENDOR $25,000/$50,000 IDENTITYTHEFTCVRGE ENDORSEMT $25,000.00 TOTAL POLICY PREMIUM INCLUDING ASSESSMENTS AND ALL SURCHARGES: SEE REVERSE SIDE PREMIUM CHANGE DUE TO RATE CHANGE PREMIUM CHANGE DUE TO COVERAGE CHANGE PLEASE CONTACT YOUR AGENT IF THERE ARE ANY QUESTIONS PERTAINING TO YOUR POLICY. PREMIUMS $4,565.00 INCLUDED INCLUDED INCLUDED $18.00 INCLUDED INCLUDED INCLUDED $50.00 $25.00 $4,828.00 0.00 50.00 FORMS AND ENDORSEMENTS HO 0355 (01/06) H0 -0490 (04/91) OIRB11655 (02/10) *SFH FL EQ (02/06) Continued on Forms Schedule *HO -0109 (12/12) H0 -0496 (10 /00) *OIRB11670 (01/06) SFHFLD3 (04/05)' COUNT BY SIGNED DATE 0•/10/2013 ADDITIONAL INTERESTS MORTGAGEE CITY OF OKEECHOBEE 55 SE 3RD AVENUE OKEECHOBEE FL 34974 INSURED'S COPY II %/nu L.A.# GRJ LOCA., LJAM/41 1 Kiri w li i SFI P.O. Box 16029 Tallahassee FL 32317-6029 &none, n lidelit Insuronve Company POLICY NUMBER SHO 1030675 04 69 11/04/2012 11/04/2013 1201 AM. Standard Time at the IjeSCIIbSd location or Customer $ervice and Claims Caft 1-866-8747342. RENEWAL DECLARATION Effective: 1 /20 2 Date Issued: 09/05/2012 INSURED: AGENT: O90O154 -- \ EDWARD J SIZEMORE PHILIP BERGER 203 SW 21ST STREET BERGER INSURANCE SERVICES, INC OKEECHOBEE FL 34974- P.O. BOX 159 OKEECHOBEE, FL 34973 Telephone: 863467-8178 Telephone: 863 763 6411 The residence premises covered by is policy is located at e above insured address unless otherwise stated below: 203 SW 21ST STREET OKEECHOBEE FL 34974- IF PAYMENT IS NOT RECEIVED ON OR BEFORE THE POLICY RENEWAL EFFECTIVE DATE, THIS POLICY WILL NOT BE IN FORCE. Coverage is provided Mere premium and limit of liability is shown. Flood coverage is not provided by SOUTHERN FIDELITY and is not a part of this policy. SECTION I COVERAGE A DWELLING B. OTHER STRUCTURES C. PERSONAL PROPERTY D. LOSS OF USE SECTION 11 COVERAGE E. PERSONAL LIABILITY F MEDICAL PAYMENTS LIMIT OF LIABILITY $306,000.00 $30,600.00 $153,000.00 $61,200.00 $300,000.00 $1,000.00 PREMIUMS $4,565.00 INCLUDED INCLUDED INCLUDED $18.00 INCLUDED OPTIONAL COVERAGES Replacement Cost Contents INCLUDED LIMITED FUNGI,ROT BACTERIA $10,000/$20,000 INCLUDED IDENTITY THEFT CVRGE ENDORSE MT $25,000.00 TOTAL POLICY PREMIUM INCLUDING ASSESSMENTS AND ALL SURCHARGES: SEE REVERSE SIDE PREMIUM CHANGE DUE TO RATE CHANGE PREMIUM CHANGE DUE TO COVERAGE CHANGE PLEASE CONTACT YOUR AGENT IF THERE ARE ANY QUESTIONS PERTAINING TO YOUR POLICY. $25.00 $4,744.00 492.00 25.00 F. - MS AND ENDOW ENTS . HO 0355 (01/06) H0-0490 (04/91) 0IR811655 (02/10( SFHFLD3 (04/05) Continued on Forms Schedule 'HO-0109 (09/11) H0-0496 (10/00) *01RB11670 (01106) SFHFLHD (04/05) COUNTERS GNED DATE 09/05/2012 BY v'ina ADDITIONAL INTERESTS MORTGAGEE CITY OF OKEECHOBEE 55 SE 3RD AVENUE OKEECHOBEE FL 34974 AGENT'S COPY rIVIVICV Vv cno UCVLMRM 1 ivw ISFI C P.O. Box 16029 Tallahassee FL 32317 -6029 Southern Fidelity Insurance Company POLICY N IVIBER POUCY PERIOD From To SHO 1030675 03 69 11/04/2011 11/04/2012 12:01 A.M. Standard Time at the described loca For Customer Service. and Ctaims CaII::1 866- 874, 7:342 ::. RENEWAL DECLARATION Effective: 11/04/2011 Date Issued: 09/05/2011 IN SURER :::; :;AGENT :0900154: EDWARD J SIZEMORE PHILIP BERGER 203 SW 21ST STREET BERGER INSURANCE SERVICES, INC OKEECHOBEE FL 34974- P.O. BOX 159 OKEECHOBEE, FL 34973 Telephone: 863 - 467 -8178 Telephone: 863 763 6411 The residence premises covered by this policy is located at the above insured address unless otherwise stated below: 203 SW 21ST STREET OKEECHOBEE FL 34974 - IF PAYMENT IS NOT RECEIVED ON OR BEFORE THE POLICY RENEWAL EFFECTIVE DATE, THIS POLICY WILL NOT BE IN FORCE. Coverage is provided where premium and limit of liability is shown. Flood coverage is not provided by SOUTHERN FIDELITY and is not a part of this policy. SECTION I COVERAGE LIMIT OF LIABILITY A. DWELLING $306,000.00 B. OTHER STRUCTURES $30,600.00 C. PERSONAL PROPERTY $153,000.00 D. LOSS OF USE $61,200.00 SECTION II COVERAGE E. PERSONAL LIABILITY $300,000.00 F. MEDICAL PAYMENTS $1,000.00 OPTIONAL COVERAGES Replacement Cost Contents LIMITED FUNGI,ROT BACTERIA $10,000/$20,000 TOTAL POLICY PREMIUM INCLUDING ASSESSMENTS AND ALL SURCHARGES: SEE REVERSE SIDE PREMIUM CHANGE DUE TO RATE CHANGE PREMIUM CHANGE DUE TO COVERAGE CHANGE PLEASE CONTACT YOUR AGENT IF THERE ARE ANY QUESTIONS PERTAINING TO YOUR POLICY. PREMIUMS $4,073.0 INCLUDE INCLUDE INCLUDE $18.0 INCLUDE INCLUDE INCLUDE $4,218.0 243.0 130.0 FORMS AND:EN©ORS:EMENTS :' HO 0355 (01/06) `H0-0109 (11/10) H0-0490 (04/91) H0-0496 (10/00) "OIRB11655 (02/10) SFHFLD3 (04/05) SFHFLHD (04/05) SFHFLHJ (04/05) Continued on Forms Schedule COUNTERSIGNED BY DATE 09/05/2011 1 tDDITIONAL:INTERESTS : MORTGAGEE CITY OF OKEECHOBEE 55 SE 3RD AVENUE OKEECHOBEE FL 34974 MORTGAGEE'S COPY TOTAL WIND MITIGATION CREDITS ROOF COVER FBC EQUIVALENT ROOF DECK 6d @ 6/12 ROOF SHAPE OTHER ROOF SHAPE - GABLE /FLAT ROOF WALL TOE NAILS OPEN PROTECTION NONE SWR NO SWR TERRAIN TERRAIN B 2% DED FBC WIND SPEED MPH N/A WIND SPEED OF DESIGN N/A INTERNAL PRESSURE N/A WBDR N/A SFHFLH3 (08/02) SFHFLOL (04/09) SFHFLSL (04/09) SFHFLIG (04/05) SFHFLPC (04/05) Policy Number Policy.Penod From Ta SHO 1030675 03 69 11/04/2011 11/04/2012 12:01 A.M. Standard Time at the described location FORMS SCHEDULE (continued from page 1) SFHFLLA (04/05) SFHFLPN (04/05) SFHFLMC3 (04/05) SFHFLRL3 (04/09) SFHFLME (04/05) SFHFLSC (04/05) LAW AND ORDINANCE COVERAGE IS AN IMPORTANT COVERAGE THAT YOU MAY WISH TO PURCHASE. YOU MAY ALSO NEED TO CONSIDER THE PURCHASE OF o FLOOD INSURANCE FROM THE NATIONAL FLOOD INSURANCE PROGRAM. WITHOUT THIS COVERAGE, YOU MAY HAVE UNCOVERED LOSSES. PLEASE DISCUSS THESE COVERAGES WITH YOUR INSURANCE AGENT. SFIC FL FS 09/02 MORTGAGEE'S COPY HOMEOWNERS DECLARATION 1 Tallahassee FL 32317 -6029 SFICP.O. Box 1e FL Southern Fidelity Insurance Company .......................... ....... ..................... .......... O £ICY:?ERIOflS ..`:.:PQLICY:140VIBER ; SHO 1030675 02 69 11/04/ 2010 11 /04/2011 1 2:01 A.M. Standard Time at the described location ::� .. . •:t=or:*wi4sto�er]erziics; aril: Ctaii�s :.Ca,t......86fi44�'i4;P.. g, .. ..................... .... ... ................... ....... ......... RENEWAL DECLARATION Effective: 11/04/2010 Date Issued: 09/06/2010 : :11IS:UftED.......::.. :: :::::::.:::::.::::::::::::::::: ::::::: ::::::::::::::::::::::;::JXdtti :::::;:::::b9x01:5:.::::::.:. :::-.:::.:::. .. .... ........... ..... . • EDWARD J SIZEMORE PHILIP BERGER 203 SW 21ST STREET BERGER INSURANCE SERVICES, INC OKEECHOBEE FL 34974- P.O. BOX 159 OKEECHOBEE, FL 34973 Telephone: 863 -467 -8178 Telephone: 863 - 763 -6411 The residence premises covered by this policy is located at the above insured address unless otherwise stated below: 203 SW 21ST STREET OKEECHOBEE FL 34974- IF PAYMENT IS NOT RECEIVED ON OR BEFORE THE POLICY RENEWAL EFFECTIVE DATE, THIS POLICY WILL NOT BE IN FORCE. Coverage is provided where premium and limit of liability is shown. Flood coverage is not provided by SOUTHERN FIDELITY and is not a part of this policy. SECTION I COVERAGE A. DWELLING B. OTHER STRUCTURES C. PERSONAL PROPERTY D. LOSS OF USE SECTION 11 COVERAGE E. PERSONAL LIABILITY F. MEDICAL PAYMENTS OPTIONAL COVERAGES Replacement Cost Contents LIMITED FUNGI,ROT BACTERIA LIMIT OF LIABILITY $297,100.00 $29,710.00 $148,550.00 $59,420.00 $300,000.00 $1,000.00 $10,000/$20,000 TOTAL POLICY PREMIUM INCLUDING ASSESSMENTS AND ALL SURCHARGES: SEE REVERSE SIDE PREMIUM CHANGE DUE TO RATE CHANGE PREMIUM CHANGE DUE TO COVERAGE CHANGE COVERAGES HAVE BEEN INCREASED TO HELP KEEP PACE WITH RISING REPLACEMENT COSTS. PLEASE CONTACT YOUR AGENT IF THERE ARE ANY QUESTIONS PERTAINING TO YOUR POLICY. PREMIUMS $3,700.00 INCLUDED INCLUDED INCLUDED $18.00 INCLUDED INCLUDED INCLUDED $3,854.00 843.00 120.00 HO 0355 (01/06) HO -0490 (04/91) OIRB11655 (07/07) SFHFLHD (04/05) Continued on Forms Schedule * HO -0109 (04/09) HO -0496 (10/00) SFHFLD3 (04/05) SFHFLHJ (04/05) COUNTERSIGNED DATE 09/06/2010 BY ....... ............................... MORTGAGEE CITY OF OKEECHOBEE 55 SE 3RD AVENUE OKEECHOBEE FL 34974 MORTGAGEE'S COPY 0000003133 HOMEOWNERS DECLARATION Ilir SFI C P.O. Box 16029 Tallahassee FL 32317 -6029 Southern Fidelity Insurance Company .:_:::PQLICY::MIJMBER ::: :: : :Frorti :PP EE` :::Tv SHO 1030675 02 69 11/04/2010 11 /04/201 1 12:01 A.M. Standard Time at the described location s CaIF::= B& 6= 8742 :::::::::::::::: >.::::::::::::: ;::`:::::::::::::: `:::::::::;;:::: for ::Q403.mec:$000.e::000::Cfarm ................ ........... ............................... RENEWAL DECLARATION Effective: 11/04/2010 Date Issued: 09/06/2010 fNT..:::::: ::: 08001:$: 4: ::::::::::::::: ::::::::::::::::::::::::::::::: : 111$: UfiEp :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::::::::::: �G ............................. . EDWARD J SIZEMORE PHILIP BERGER 203 SW 21ST STREET BERGER INSURANCE SERVICES, INC OKEECHOBEE FL 34974- P.O. BOX 159 OKEECHOBEE, FL 34973 Telephone: 863 - 467 -8178 Telephone: 863 - 763 -6411 The residence premises covered by this policy is located at the above insured address unless otherwise stated below: 203 SW 21ST STREET OKEECHOBEE FL 34974- All Note: The portion other perils deductible: $ 500.00 Hurricane deductible: $ 5,942.00 Premium: $ 3,854.00 of your premium for Hurricane Coverage is: SECTION I, SECTION II AND OPTIONAL PREMIUMS EMERGENCY MANAGEMENT TRUST FUND SURCHARGE MGA POLICY FEE FLORIDA HURRICANE CATASTROPHE FUND CITIZENS EMERGENCY HRA ASSESSMENT FLORIDA 2009 INSURANCE GUARANTY FUND ASSESSMENT TOTAL POLICY PREMIUM INCLUDING ASSESSMENTS AND ALL SURCHARGES FORM TYPE CONSTRUCT TYPE TERRITORY USE CODE COUNTY CODE PROT DEV/SPRINKLER REPLACEMENT COST HO -3 YEAR BUILT M CONSTRUCT SUPERIOR 555 PROTECTION CLASS P HOME UPDATED 047 PROT DEVICE/BURGLAR N EXCLUDE CONTENTS Y OCCUPANCY CODE 1965 N 04 N N N OWNER $ 1,744.00 $ 3,718.00 $ 2.00 $ 25.00 $ 37.00 $ 52.00 $ 20.00 $ 3,854.00 TOWN/ROW HOUSE NUMBER OF FAMILIES PRIOR DEC S/C MUNICIPAL CODE PROT DEVICE/FIRE WINDMAIL EXCLUSION THIS POLICY CONTAINS A SEPARATE DEDUCTIBLE FOR HURRICANE LOSSES, WHICH MAY RESULT IN HIGH OUT OF POCKET EXPENSES TO YOU. MORTGAGEE'S COPY N 1 706 N N 0000003134 Southern Fidelity Insurance Company P.O. Box 16029 Tallahassee FL 32317 -6029 For WStoiner:$:eivic <aiicl::C:I4irris:CaIt I ;:$568' : >j HOMEOWNERS SHO 1030675 02 69 11/04/2010 1 1 /04/201 1 12:01 A.M. Standard Time at the described location MORTGAGEE'S COPY Date Issued: 09/07/2010 EDWARD J SIZEMORE 203 SW 21ST STREET OKEECHOBEE FL 34974- Telephone: 863- 467 -8178 AGENT: 99 00154 PHILIP BERGER BERGER INSURANCE SERVICES, INC P.O. BOX 159 OKEECHOBEE, FL 34973 Telephone: 863 - 763 -6411 The residence premises covered by this policy is located at the above insured address unless otherwise stated below: 203 SW 21ST STREET OKEECHOBEE FL 34974- INST DATE TRANSACTION 01 09/06/2010 Renewal Premium AMOUNT DUE: PAYMENT DUE POLICY BALANCE 11/04/2010 3,854.00 PREMIUM NOTICE - INSURED DETACH ALONG THIS PERFORATION BELOW AMOUNT 3,854.00 3,854.00 RETURN THIS PORTION WITH YOUR REMITTANCE SHO 1030675 02 00 69 0900154 EDWARD J SIZEMORE 203 SW 21ST STREET OKEECHOBEE FL 34974- SFH FL N1 09/02 LOAN NUMBER: AMOUNT DUE PLEASE REMIT PAYMENT TO: 11 #19 Southern Fidelity Insurance P.O. Box 31148 Tampa, SHO 10306750269000000385400101011196 FL33631 -3148 0000003131 HOMEOWNERS DECLARATION 1 SFIC P.O. Box 16029 Tallahassee FL 32317 -6029 Southern Fidelity Insurance Company ............................... .................... ........... ..... POiLICY:I ILJMBER: SHO 1030675 01 69 11/04/2009 11 /04/2010 12:01 A.M. Standard Time at the described location • �: For; �iisto�ex::: ei�ii.,a•..d,.�.,aim�;Ca.>�.,._.,.8 ............. ................... ............................. ...................... RENEWAL DECLARATION Effective: 11/04/2009 Date Issued: 09/16/2009 : :: ::A EI\IT :::::::::: 09b 0j:$ 4: :::::.... ::.....: HOMEOWNERS DECLARATION All Note: The portion other perils deductible: $ 500.00 Hurricane deductible: $ 5,768.00 of your premium for Hurricane Coverage is: SECTION I, SECTION II AND OPTIONAL PREMIUMS EMERGENCY MANAGEMENT TRUST FUND SURCHARGE MGA POLICY FEE Premium: $ 2,851.00 FLORIDA HURRICANE CATASTROPHE FUND CITIZENS EMERGENCY HRA ASSESSMENT 2007 FLORIDA INSURANCE GUARANTY FUND ASSESSMENT TOTAL POLICY PREMIUM INCLUDING ASSESSMENTS AND ALL SURCHARGES FORM TYPE CONSTRUCT TYPE TERRITORY USE CODE COUNTY CODE PROT DEV /SPRINKLER REPLACEMENT COST HO -3 M 555 P 047 N Y YEAR BUILT CONSTRUCT SUPERIOR PROTECTION CLASS HOME UPDATED PROT DEVICE/BURGLAR EXCLUDE CONTENTS OCCUPANCY CODE 1965 N 04 N N N OWNER $ 1,292.00 $ 2,755.00 $ 2.00 $ 25.00 $ 28.00 $ 39.00 $ 2.00 $ 2,851.00 TOWN/ROW HOUSE NUMBER OF FAMILIES PRIOR DEC S/C MUNICIPAL CODE PROT DEVICE/FIRE WINDMAIL EXCLUSION THIS POLICY CONTAINS A SEPARATE DEDUCTIBLE FOR HURRICANE LOSSES, WHICH MAY RESULT IN HIGH OUT OF POCKET EXPENSES TO YOU. MORTGAGEE'S COPY N 1 706 N N 0000004232 P.O. Box 16029 Tallahassee FL 32317 -6029 Company .::: POLICY:: NLFIVIBER ::::::::::::::: :.:................... ......:R1 :............. 1 Southern Fidelity Insurance SHO 1030675 01 69 11/04/2009 11/04/2010 12:01 A.M. Standard Time at the described location f-or::c4.5 omer:000.0::ari0::P.01.1 is 011:::1 86:6 =87. 74Z ::::::::: ::::.:::::::: ::::::.:::::::::::::::::::: ....................................................................................................... ............................... RENEWAL DECLARATION Effective: 11/04/2009 Date Issued: 09/16/2009 .......................................................................................................... .............................. 1118: Uf# ED :::::::::::::::::::::::::::::::::::::::::.::::::::::::::::::: :::::::::Cyf�11T::::::::::0? 3001:4 ::::::::::::::::::::::::::::: ::::::::::::::::::::::::::::::: ........................................ ............................... .117.4.......................... ............................... EDWARD J SIZEMORE PHILIP BERGER 203 SW 21ST STREET BERGER INSURANCE SERVICES, INC OKEECHOBEE FL 34974- P.O. BOX 159 OKEECHOBEE, FL 34973 Telephone: 863 - 467 -8178 Telephone: 863- 763 -6411 The residence premises covered by this policy is located at the above insured address unless otherwise stated below: 203 SW 21ST STREET OKEECHOBEE FL 34974- All Note: The portion other perils deductible: $ 500.00 Hurricane deductible: $ 5,768.00 of your premium for Hurricane Coverage is: SECTION I, SECTION II AND OPTIONAL PREMIUMS EMERGENCY MANAGEMENT TRUST FUND SURCHARGE MGA POLICY FEE Premium: $ 2,851.00 FLORIDA HURRICANE CATASTROPHE FUND CITIZENS EMERGENCY HRA ASSESSMENT 2007 FLORIDA INSURANCE GUARANTY FUND ASSESSMENT TOTAL POLICY PREMIUM INCLUDING ASSESSMENTS AND ALL SURCHARGES FORM TYPE CONSTRUCT TYPE TERRITORY USE CODE COUNTY CODE PROT DEV /SPRINKLER REPLACEMENT COST HO -3 M 555 P 047 N Y YEAR BUILT CONSTRUCT SUPERIOR PROTECTION CLASS HOME UPDATED PROT DEVICE/BURGLAR EXCLUDE CONTENTS OCCUPANCY CODE 1965 N 04 N N N OWNER $ 1,292.00 $ 2,755.00 $ 2.00 $ 25.00 $ 28.00 $ 39.00 $ 2.00 $ 2,851.00 TOWN/ROW HOUSE NUMBER OF FAMILIES PRIOR DEC S/C MUNICIPAL CODE PROT DEVICE/FIRE WINDMAIL EXCLUSION THIS POLICY CONTAINS A SEPARATE DEDUCTIBLE FOR HURRICANE LOSSES, WHICH MAY RESULT IN HIGH OUT OF POCKET EXPENSES TO YOU. MORTGAGEE'S COPY N 1 706 N N 0000004232 HOMEOWNERS 1 SFIC P.O. Box 16029 Tallahassee FL 32317 -6029 Southern Fidelity Insurance Company _.:.:P liLICY::NLJMB:ER::_: Southern Fidelity Insurance Company P.O. Box 16029 Tallahassee FL 32317 -6029 :sir: Custome : :Setkiie Atid::C:Iaii is:: Cali: :1: =:8 HOMEOWNERS DECLARATION : PO L1 CY::NUMBER: SHO 1030675 00 69 POLICY: PERIOD::::: 11/04/2008 1 1 /04/2009 12:01 A.M. Standard Time at the described location AMENDED DECLARATION CORRECT MORTGAGEE ................. INS.Uf ED ::: Effective: 03/06/2009 Date Issued: 03/27/2009 AGf 11T:::::::: : : :0 &9:i:5 ;4: :: :: EDWARD J SIZEMORE 203 SW 21ST STREET OKEECHOBEE FL 34974- Telephone: 863 - 467 -8178 PHILIP BERGER BERGER INSURANCE SERVICES, INC P.O. BOX 159 OKEECHOBEE, FL 34973 Telephone: 863 - 763 -641 1 The residence premises covered by this policy is located at the above insured address unless otherwise stated below: 203 SW 21ST STREET OKEECHOBEE FL 34974- Coverage is provided where premium and limit of liability is shown. Flood coverage is not provided by SOUTHERN FIDELITY and is not a part of this policy. SECTION I COVERAGE LIMIT OF LIABILITY A. DWELLING B. OTHER STRUCTURES C. PERSONAL PROPERTY D. LOSS OF USE SECTION II COVERAGE E. PERSONAL LIABILITY F. MEDICAL PAYMENTS OPTIONAL COVERAGES Replacement Cost Contents LIMITED FUNGI,ROT BACTERIA $280,000.00 $28,000.00 $140,000.00 $56,000.00 $300,000.00 $1,000.00 $10,000/$20,000 TOTAL POLICY PREMIUM INCLUDING ASSESSMENTS AND ALL SURCHARGES: SEE REVERSE SIDE PLEASE CONTACT YOUR AGENT IF THERE ARE ANY QUESTIONS PERTAINING TO YOUR POLICY. :>fi.Ot�ltll:S >A�ID :ENtiiiRSEMEIV�'� HO 0355 (01/06) HO -0490 (04/91) OIRB11655 (07/07) SFHFLHD (04/05) Continued on Forms Schedule PREMIUMS $2,649.00 INCLUDED INCLUDED INCLUDED $18.00 INCLUDED INCLUDED INLCUDED $2,782.00 A ODmOl11i41::`.1NTERES:TS MORTGAGEE H0-0109 (04/05) HO -0496 (10/00) SFHFLD3 (04/05) SFHFLHJ (04/05) COUNTERSIGNED DATE 03/27/2009 BY CITY OF OKEECHOBEE 55 SE 3RD AVENUE OKEECHOBEE FL 34974 MORTGAGEE'S COPY 0000003039 HOMEOWNERS DECLARATION P.O. Box 16029 Illr S1'IM Tallahassee FL 32317 6029 Southern Fidelity Insurance Compan :::PO lel!:;NUMBEFi:::::: :::: • Froi6:: • • :� To SHO 1030675 00 69 1 1 /04/2008 11/04/2009 12:01 A.M. Standard Time at the described location .:7342_ ::: :: : :•: ::::::::::: : :.: : :::.:::::::: ::::::::::::::::::::.:::::::::: : :Fo::G:iisfl�rrier: Servi�ce:and::Ctaims: Ga11::1 8:G6= :874...7 . .. .................. ... . . AMENDED DECLARATION Effective: 03/06/2009 Date Issued: 03/27/2009 CORRECT MORTGAGEE ...................................................... ............................... 1:84 :::::.:::::::::::::::::::: .: EDWARD J SIZEMORE PHILIP BERGER 203 SW 21ST STREET BERGER INSURANCE SERVICES, INC OKEECHOBEE FL 34974- P.O. BOX 159 OKEECHOBEE, FL 34973 Telephone: 863 - 467 -8178 Telephone: 863 - 763 -6411 The residence premises covered by this policy is located at the above insured address unless otherwise stated below: 203 SW 21ST STREET OKEECHOBEE FL 34974- Note: All other perils deductible: $ 500.00 Hurricane deductible: $ 5,600.00 The portion of your premium for Hurricane Coverage is: Premium: SECTION I, SECTION II AND OPTIONAL PREMIUMS EMERGENCY MANAGEMENT TRUST FUND SURCHARGE MGA POLICY FEE 2006 REGULAR FLORIDA INSURANCE GUARANTY FUND ASSESSMENT FLORIDA HURRICANE CATASTROPHE FUND CITIZENS EMERGENCY HRA ASSESSMENT 2007 FLORIDA INSURANCE GUARANTY FUND ASSESSMENT 2006 FLORIDA EMERGENCY INSURANCE GUARANTY FUND ASSESSMENT TOTAL POLICY PREMIUM INCLUDING ASSESSMENTS AND ALL SURCHARGES FORM TYPE CONSTRUCT TYPE TERRITORY USE CODE COUNTY CODE PROT DEV /SPRINKLER REPLACEMENT COST $ 1,416.00 $ 1,251.00 2,667.00 2.00 25.00 1.00 27.00 37.00 19.00 4.00 $ 2,782.00 CHANGE IN POLICY PREMIUM $ 0.00 HO -3 YEAR BUILT M CONSTRUCT SUPERIOR 555 PROTECTION CLASS P HOME UPDATED 047 PROT DEVICE/BURGLAR N EXCLUDE CONTENTS Y OCCUPANCY CODE 1965 N 04 N N N OWNER TOWN /ROW HOUSE NUMBER OF FAMILIES PRIOR DEC S/C MUNICIPAL CODE PROT DEVICE /FIRE WINDMAIL EXCLUSION N 1 N 706 N N THIS POLICY CONTAINS A SEPARATE DEDUCTIBLE FOR HURRICANE LOSSES, WHICH MAY RESULT IN HIGH OUT OF POCKET EXPENSES TO YOU. MORTGAGEE'S COPY 0000003040 A Rpu CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 03/06/2009 TYPE OF INSURANCE PRODUCER (863) 763 -6411 FAX (863) 763 -4569 Berger Insurance Servi ces , Inc . 800 South Parrott Avenue P.O. Box 158 Okeechobee, FL 34973 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERT FICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Edward 3 Sizemore Sr 203 S.W. 21st Street Okeechobee, FL 34974 INSURER A: Southern Fidelity Ins Co l INSURER B: INSURER C: INSURER D: $ INSURER E: DAMAGE TO RENTED PRFMLSFS (Fq nrrlamnrw) THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR A � TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE „SATE /MM/oD/YY1 POLICY EXPIRATION DATE IMM/DO/YY1 LIMITS GENERAL LIABILITY' COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED PRFMLSFS (Fq nrrlamnrw) $ CLAIMS MADE 1 1 OCCUR MED EXP (My one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY n jpeT [1 LOC PRODUCTS - COMP /OP AGG $ —1 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ (Per dent) INJURY (Per accidenlj $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ —1 OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below I TORY I IAMIT3 I FR E.L EACH ACCIDENT $ EL DISEASE - EA EMPLOYEE $ E.L DISEASE - POLICY LIMIT $ A Homeowner SHO 1030675 11/04/2008 11/04/2009 $300,000 each occurrence DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Certificate holder shown below is added as additional insured as respects the following: a 15 feet alley right -of -way which runs North to South between Lots 1 to 8 of Block 45, City of Okeechobee. City of Okeechobee 55 SE 3rd Avenue Okeechobee, FL 34974 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ACORD 25 (2001/08) AUTHORIZED REPRESENTATIVE Philip Y. Berger ei+ CORD CORP TION 1988 11- 10 -'06 11:42 FROM- Berger Insurance Miel Insurance Companies ENDORSEMENTS COMPLETES THIS DECLARATIONS PAGE WITH POLICY FORMS AND THE POLICY. THIS POLICY WILL CONTINUE IN FORCE FOR THE PERIOD INDICATED UPON VALID PAYMENT OF THE PREMIUM, WHEN DUE. 1- 863 - 763 -4569 T -167 P003/005 F -300 MOBOECFL HOP 0719233 20 20060920 WFS SIZE HP "R 0 93ERG0007501 034974 STATE AUTO RENEWAL DECLARATIONS HOMEOWNERS POLICY a PO1.1CY NUMBER HDP 0719233 NAMED INSURED AND ADDRESS EDWARD J SIZEMORE SR 203 SW 21ST STREET OKEECHOBEE FL 34974 COVERAGE I$ PROVIDED IN THE FOLLOWING COMPANY STATE AUTO FLORIDA INS CO AGENCY 7501 PROD 00 AGENT BERGER INSURANCE SERVICES INC PO BOX 159 OKEECHOBEE FL 34973 TELEPHONE 863/763 -6411 YOUR 2% CALENDAR YEAR HURRICANE DEDUCTIBLE IS $4,704_ NOTICE - THE ACTUAL CALENDAR YEAR HURRICANE DEDUCTIBLE AMOUNT MAY BE HIGHER AT THE TIME OF LOSS DUE TO APPLICATION OF INFLATION GUARD PROTECTION. TEE PREMISES COVERED BY THIS POLICY IS LOCATED AT THE ABOVE ADDRESS. IF YOU HAVE ANY QUESTIONS ABOUT YOUR POLICY OR NEED HELP RESOLVING A COMPLAINT, PLEASE CALL 1- 800 - 234 -1878. RATING INFORMATION- FORM 3, MASONRY, CONSTRUCTED IN 1964, PRIMARY RESIDENCE, PROTECTION CLASS 06, TERRITORY 53, FEET FROM HYDRANT 1000, FIRE STATION 3 MILES, SEC. -I DEDUCTIBLE $500 EXCEPT 2% FOR HURRICANE LOSS, 1 FAMILY, INSIDE CITY. DUE TO INCREASED CONSTRUCTION COSTS, SECTION I COVERAGES HAVE BEEN INCREASED BY 7.0% COVERAGE AT THE ABOVE DESCRIBED LOCATION IS PROVIDED ONLY WEERE A LIMIT OF LIABILITY IS SHOWN OR A PREMIUM IS STATED SECTION I COVERAGE A. DWELLING B. OTHER STRUCTURES C. PERSONAL PROPERTY D. LOSS OF USE LIMIT OF LIABILITY PREMIUMS $235,200 $23,520 $164,640 $47,040 SECTION II COVERAGE E. PERSONAL LIABILITY $300,000 F. MEDICAL PAY. TO OTRERS - $1,000 TOTAL BASIC PREMIUM ADDITIONAL PREMIUMS ADDITIONAL RESIDENCE RENTED TO OTHERS, HO -70 ADDITIONAL RESIDENCE RENTED TO OTHERS, HO -70 WATERCRAFT, EO -75 FLORIDA SURCHARGE ASSESSMENT RECOUPMENT TOTAL ADDITIONAL TOTAL ANNUAL PREMIUMS PREMIUM EACH OCCURRENCE EACH PERSON * ** YOUR HOMEOWNERS POLICY HAS BEEN DISCOUNTED AS SHOWN BELOW: YOU HAVE RECEIVED AN AUTO /HOME DISCOUNT OF $165 ORDINANCE LAW COVERAGE REJECTED HURRICANE PREMIUM $700.70 POLICY PERIOD- 12 -01 AM STANDARD TIME AT THE RESIDENCE PREMISES. $981.00 $20.00 $1,001.00 $13.00 $413.00 4.00 $2.00 $16.00 $88.00 $1,089.00 FL- DEC -HO 01/06 MORTGAGE DEED TO CORPORATION FROM INDIVIDUAL '4,(e,"7,'" 77.7E7 DREW'S FORM R. E. 35 .Manufacru •d and for sale by The H. & W. 5. Drew Company Jos ksonville, Florida •`?: 50 ...1.9.7 This mortgage deed Executed the 18th day of AUGUST EDWARD J. SIZEMORE AND FRANCES SIZEMORE, HUSBAND & WIFE hereinafter called the mortgagor, to OKEECHOBEE COUNTY BANK a corporation existing under the laws of the State of FLORIDA address at P. 0. BOX 218, OKEECHOBEE, FLORIDA hereinafter called the mortgagee: A. D. t o65 by , u,itlt its permanent posto ice (Wherever used herein the terns "mortgagor" and "mortgagee" include all the parties to this instrument and the heirs, legal representatives and assigns of individuals, and the successors and assigns of corporations; and the term "note" includes all the notes herein described if more than one.) itnesseth, that for good and valuable considerations. and also in consideration of the aggre- gate sum named in the promissory note of even date herewith, hereinafter described, the mortgagor here- by grants, bargains, sells, aliens, remises, conveys and confirms unto the mortgagee all the certain land of which the mortgagor is now seized and in possession situate in OKEECHOBEE County, Florida, viz: Lots 1, 2, 3 and 4 of Block 45, First Addition to South Okeechobee, an addition to the City of Okeechobee, according to plat thereof on file in the Office of Clerk of Circuit Court of Okeechobee County, Florida, in Plat Book 1, page 17. And excepting the North 3 feet of Lot 1 of Block 45 above described. Said lots lying in and comprising a part of East half of NE4 of Section 28, Town- ship 37 South, Range 35 East lying West of Parrott Avenue. Less the South 519.3 feet thereof. "Previded fu;*tker Met old!! mortgagors do hereby consent an.a agree with said mortgagee, that they will not, during the rcricl of tiro this rlortgage is in effect, either sell, convey, cr ^ :^ b sal or co:rrey the proncrty covered by this mortgage wh ^':j Cu _ p^,^ 1.7C71.1 be as�Ulne:J (7i itcNlt the S'ritten cense;:t o the TAT' %I .. .l� ljr :'iC'.a- tion of thi3 rrovisien Clan grant unto the rig'It to de- clare the total balance remaining, due at the date of such violation." This mortgage shall also secure the payment of any future advances or loans that may mull by the mort��, try h morir7ar. :r : m , at i' ti ten years h ^r a [cr, e'.' ;n t'lou' '1 no inct.-*. - i , >'.It- standi;: n, u:, :r; pro;.'.' :d lit: t t'r_ Ir; :. i.:r_ n prin- ci 11 i:f'' u: i O $p27,200.00 at C.71y on fi pro- vided fur :rvr that such advances or loans shall be evid'anced by separate written instruments to invoke the terms hcreof. Receipt No.Zil��siled__����� for payment of Intangih' C tax in the amount of t - Tax Collector, C, , 3'1 tiO v] To Eau and to Mold the same. together / with the tenements, Itereditaments and appurte- Dances thereto belonging, and the rents, issues and profits thereof, unto the mortgagee, in fee simple. find the mortgagor cotenants with the mortgagee That the mortgagor is indefeasibly seized of said land in foe simple: that the mortgagor has good right and lawful authority to convey said land as afore- said: that the mortgagor will matte such further assurances to perfect the fee simple title to said land in the mortgagee as may reasonably be required; that the mortgagor hereby fully warrants the title to said land and will defend the same against the lawful claims of all persons whomsoever; and that said land is free and clear of all encumbrances frotoided WalJS, 11101 if said mortgagor shall pay unto said mortgagee the certain prontis- sory note hereinafter substantially copied or identified. to -wit: COPY COPY COPY $.27,200.00 ..... ............................... NO.. OKEECHOBEE, FLA., ........ August 18, 1965 FOR VALUE RECEIVED, I, we, or either of us, promise to pay to the order of OKEECIIOBEE COUNTY BANK at Its office in this city the principal sum of Twenty —Seven Thousand Two Hundred And No /100 Dollars monthly six date aria interest, with Interest payable at the rate of per annum from said principal to he paid as follows: $200.00„, the 1st dev of October 7 19 65 and $200.00 on the 1st <1.1N of each and every month 1 f� thereafter until the 1St day of September 19--, on which said date the entire balance of principal then unpaid shall he- come due and payable. In case sold Installments. or any of them, are not paid after the same become due, the whole of said principal sum shall forthwith become due and payable at the option of the holder of this note. This note Is for value received, negotiable and pay- able at the office of said bank. and if not paid nt maturity may be placed In the hands of an attorney at law for collection: and, In that event. It Is agreed and promised by the makers and endorsers, severally. to pay all costs of collection. Including a reasonable attorney's fee; and having deposited with said hank as collateral security for the payment of this note, and any note given In extension or renewal there- of. and as eecurity for the navme• t of any other liability or liabilities of the undersigned to said bank, whether now existing or hereafter ariang, the ollowing property, viz: Secured by real estate mortgage of even date hereto and to which reference is hereby made. Also, in addition to the above schedule, a principal payment of $3,250.00 shall be due anc payable on March 1, 1966 and a like amount on the same day of each annual period there -_.. after, with the balance due on September 1, 1970, as above stated. Which the undersigned represents and covenants to be the property of the undersigned, free and unencumbered, and that the undersigned Is possessed of the full legal right and power to make this pledge and with authority to sell the same on the non - performance of this promise In such manner as the said bank, or Its authorized agent, or the holder thereof, In their discretion may deem proper, without notice, either at any broker's board or at public or private sale, and to apply the proceeds thereon and for any other liabilities to the said bank, whether due, or not due, or hereafter arising, the undersigned also gives to said bank a lien upon all property or securities given to or left in the possession of the said bank by the undersigned, and also upon any balance of the deposit account of the undersigned with said bank. And do further agree. whenever the total market value of the securities held as collateral security for any Indebtedness or liability of the under- . signed to the said holder, shall be Insufficient to cover the entire amount of the indebtedness or liability of the undersigned to said holder, with twenty per cent margin added thereto, to deposit with said holder Immediately, upon demand, additional security. to be approved by Enid holder. sufficient to cover the said amount and margin —the said additional security to be a collateral security to the same extent as the securities hereby pledged; and in default of depositing the additional security, as above agreed, this note shall become instantly due and payable, precisely as though It had actually matured. And at any sale made by the said bank. or Its agents or officers, or of the holder here- of of the whole or any part of the securities herein mentioned, the securities sold shall be sold free from any right of redemption, and the whole interest of the pledger thereof shall pees to the purchaser or purchasers thereof. And In the case of the sale of the said securities, or any part thereof. at a public auction or at a broker's board, the said bank, or any of Its agents or officers. shall have the right to become the purchaser of the same. In case of sale of the said securities, or any part thereof, the said bank or the holder hereof, after deducting all legal and other costs for collection, sale and delivery of said property, Including attorney's fees as hereinbefore pros hied, may apply the residue of the proceeds of the sale or sales 6o made to pay this note, and then to pay any or all of the liabilities of the undersigned t said bank, whether due or not due, or hereafter arising, as any of its officers shall determine, making proper rebates for interest on liabl sties not due, returning the overplus, If any, to the undersigned; and the undersigned also agrees that the exercise or the omi lion to exercise:\by said bank or the holder hereof of any of the rights or privileges hereby conferred on said bank or the holder hereof, shall not waive or af- fect any other or subsequent right to exercise the same. And the undersigned also agrees to be and remain liable to said tank, or to the holder hereof, for any deficiency after such sale or sales so made, together with Interest thereon at the rate of Ten per cent. per annum until the same Is fully paid. WITNESS....... ADDRESS....... WITNESS rFtVt'L.if t,Ut..;11 MLly l 0951 SIAMre •. f. r,.l^,r.r....r Nf'r..f.A1VcCttEU,......... _......... Sf .Edward J. Sizemore S/ Frances Sizemore ..SEAL ....SEAL 3n K 90 1 '.,,L 195 arid shall perform, comply dill' and abide by each and every the agreertienls, stipulations, conditions, and covenants thereof, and of this mortgage, then this mortgage and the estate hereby created, shall cease, de- termine and be null and void. End the mortgagor hereby further covenants and agrees to pay promptly when due the principal and interest and other sums of money provided for in said note and this mortgage, or either; to pay all and singular the taxes, assessments, levies, liabilities, obligations, and encumbrances of every nature on said pro- perty; to permit, commit or suffer no waste, impairment or deterioration of said land or the improvements thereon at any time; to keep the buildings now or hereafter on said land fully insured in a sum of not Less than Twenty —Five Thousand And No /100 in a company or companies acceptable to the mortgagee. the policy or policies to be held by. and payable to. said mortgagee, and in the event any sum of money becomes payable by virtue of such insurance the mortgagee shall have the right to receive and apply the same to the indebtedness hereby secured, accounting to the mortgagor for any surplus; to pay all costs, charges, and expenses, including lawyers fees and title searches. reasonably incurred or paid by the mortgagee because of the failure of the mortgagor to promptly and fully comply with the agreements, stipulations, conditions and covenants of said note arul this mortgage, or either; to perform, comply with and abide by each and every the agreements, stipulations, conditions and covenants set forth in said note and this mortgage or either. In the event the mortgagor fails to pay when due any tax, assessment, insurance premium or other sum of money payable by virtue of said note and this mortgage, or either, the mortgagee rnay pay the same. without waiving or affecting the option to foreclose or any other right hereunder, and all such payments shall bear interest from date thereof at the highest law- ful rate then allowed by the laws of the State of Florida. ifany sum of money herein referred to be not promptly paid within thirty days next after the same becomes due, or if each and every the agreements, stipulations. conditions and covenants of said note and this mortgage, or either. are not fully performed, complied with and abided by. then the entire sum mentioned in said note, and this mortgage, or the entire balance unpaid thereon, shall forthwith or thereafter, at the option of the mortgagee, become and be due and payable, anything in said note or herein to the contrary notwithstanding. Failure by the mortgagee to exercise any of the rights or options herein provided shall not constitute a waiver of any rights or options under said note or this mortgage accrued or thereafter accruing. in ftness Idr hereof, tite said mortgagor has hereunto signed and sealed these presents the day and year first above written. Signed. sealed[and delivered in the presence o r yet STATE OF FLORIDA, COUNTY OF OK EECHOB ' c GOO I HEREBY CERTIFY that on this day, before me, an officer duly authorized in the State aforesaid and in the County aforesaid to take acknowledgments, personally appeared Edward J. Sizemore and Frances Sizemore to me known to be the person 3 described in and who executed the foregoing instrument and each acknowledged bcfore,,rne that they executed the same. .• ',WITNESS my hand and official seal in the County and State last aforesaid this 18th day of kugti$t A. D. 19 65. i ! 1 Prom 30 )18310 i. iI,ail 'i SNAWH L I 61 OHU S96I 'V 1: `.li P1f lOJ 3aii01133140 0803'i2! d0A 03113 SC8E90 G.�xu 7 •� Notary Public, State of Florida at Large My Commission Expires Oct. 14, 1966 Bonded by American Surety Co. of N. Y. SATISFACTION OF MORTGAGE FORM 26 FY CORPORATION s.x 126 o,cE 509 satisfaction of Mortgage Know Ell Men By These Presents: That OKEECHOBEE COUNTY BANK a corporation existing under the laws of the State of FLORIDA the owner and holder of a certain mortgage deed executed by Edward J. Sizemore & Frances Si zemo his wife. to OKEECHOBEE COUNTY BANK bearing date the 18th day of August , A.D. 19 65 , recorded in Official Records Book 90 . page 193 , in the office of the Clerk of the Circuit Court of Okeechobee County State of Florida, securing a certain note in the principal sum of ($27,200.00) Twenty -seven thousand,two- hundred & No /100 Dollars, and certain promises and obligations set forth in said mortgage deed, upon the property situate in said State and County described as follows, to -wit: Real Estate as described in said mortgage. PILED FOR OKEECHOBEE ON y, FLA. 076647 1971 ItInn 25 Ati 9:00 HA'i'FIES E. riILLIAfrIS CLERH OF CIRCUIT COURT ft�reby, o a`ckr owledges full payment and satisfaction of said note and mortgage deed, and surrenders the sarne as cancetltd, and hereby directs the Clerk of the said Circuit Court to cancel the same of record. In 'Witness hereof the said corporation has caused these presents to be executed in its name, and its corporate seal to be hereunto affixed, by its proper officers thereunto duly authorized, the 24t h clay of March , A. D. 19 71. ice Presil•ent & Cashier ed, sealedp'.nd delivere in the resence of: STATE OF FLORIDA COUNTY OF OKEECHOBEE } OKEECHOBEE COUNTY BANK President I HEREBY CERTIFY that on this day, before me, an officer duly authorized in the State and County aforesaid to take acknowledgements, personally appeared R. N. Harper & Johnny E. Johnson well known to ma to be the President and Vice Pres. & Cashier respectively of Okeechobee County Bank , a corporation, and that they severally acknowledged executing the same in the presence of two subscribing witnesses freely and voluntarily under authority duly vested•ine-thejif.by said corporation and that the seal affixed thereto is the true corporate seal of said corporation, " W1TINESS m Fiend and official seal in the County and State last aforesaid this 24th day of March This Instrument prepared by: Address Rose Mary Thomas Okeechobee County Bank P. 0. Box 218 Okeechobee, Florida 33472 , A. D. 19 71. a Commission on a.1, nr 2 My Commission Exp s July 21, 1972 Bonded by Transam a Insurance o. FORM 26 Satisfaction of Mortgage BY A CORPORATION to Dated (C -A) BOWEN SUFPLY COMPANY INC PLANT CITY FLA FORM 1132 FLORIDA Fee Simp. PERSONAL REPRESENTATIVE'S DEED TUTBLANX REGISTERED U. S. PAT. OFFICE Tuttle Law Print, Publishers, Rutland, Vt. Atli tire, a 262 : :a 23t) Wherever used herein, the term "party" shall include the heirs, personal representatives, successors and /or assigns of the respective parties hereto; the use of the singular number shall include the plural, and the plural the singular; the use of any gender shall include all genders; and, if used, the term "note" shall include all the notes herein described if more than one Made this ✓ 11th day of May 4. D. 19 84 PWe t SUN BANK AND TRUST /CHARLOTTE COUNTY, N.A. as Personal Representative of the Estate of Carlos J. Kelly of the County of Charlotte party of the first part, and EDWARD J. SIZEMORE Post Office Box 729, Belle Glade, of the County of Palm Beach party of the second part, I; I; and State of Florida and State of Florida 33430 ttttr,ssell, that the said party of the first part, for and in consideration of the sum of TEN AND NO/ 100 Dollars, to him in hand paid, the receipt whereof is hereby acknowledged, has granted, bargain- ed, sold and transferred, and by these presents does grant, bargain, sell and transfer unto the said party of the second part all that certain parcel of land lying and being in the County of Okeechobee , and State of Florida, more particularly described as follows: Punta Gorda, Fla. 33950 Lots 7, 8, 9 and 10, Block 45, FIRST ADDITION TO SOUTH OKEECHOBEE, according to the plat thereof recorded in Plat Book 1, Page 17, Public Records of Okeechobee County, Florida. • - "o CO rn �n ]TATS r ti lP 1f5�.,- Jllil 534 �; �;I I 5 7 h") v'OVtipiwith all the tenements, hereditaments and appurtenances, with every privilege, right, title, interest and estate, dower and right of dower, reversion, remainder and easement thereto belonging or in, anywise appertaining: To :t1Ftve anti to Both the same in fee simple forever. 3n IHIH tium 1918 4r f, the said party of the first part has hereunto set his hand and seal the day and year above written. Signed, Sealed and Delivered in Our Presence: (Fir 'Wi tnes (Sec'ond Witness) SUN BANK AND TRUST /CHARLOTTE COUNTY,N.A Personal Representative of the Estate of C_, lo: J. Kell B : tttte of Niortbtt QIuunt1J of CHARLOTTE i U 1 3 3}Iervttg Trrti44 That on this ,/ 11th day of May .4. D. 19 8b , before me personally appeared Sylvia N. Stalker as Trust Officer of SUN BANK AND TRUST /CHARLOTTE COUNTY, N.A. as Personal Representative of the Estate .of Carlos J. Kelly known me nown to be the person described in and who executed the foredoine con- veyance to EDWARD J. SIZEMORE the execution thereof to be its therein mentioned. I; I; and severally acknowledged free act and deed for the uses and purposes itrirs my si1nature and official seal at Port Charlotte in the County of Charlotte year last aforesaid. My Commission Expires ✓ W J a X W W U. H WANT MOM STATE OF FLORIDA NY COMMISSION EXP. DEC. 9,1987 BONDED IRRU GENERAL INS. UND. and State of Florida, ✓ J .Notary Public - State of Fior Anna Mae Bergen ✓(AFFIX SEAL) day and .0i rso c,r1 1 1— I— I —I —ni H i l l LLEYS AND CLOSED EPARED BY OKEECHOBEE RESOLUTION NUMBER ' W 15 S m m �e ami am litela '11131:11.1111t! ® wa. Mir 11FM;d ©®_t ©�q0 ..9 - © .. -- .E ,© osot =, U __ . MEM Isl- • . 3 amp °0100 �'� �;:� © M �� IIINIMMI SW 1 (.r =UMW \ 0 NEIL ■0! W0 VAMP '-‘1110W0,11M1 -0'_ 111 Mom Eris ma mea ism MEM NMI Q N NM NEM 047S:5141:M s' °ate so Zip' s© Wm - 0: VAN TA &-Ni, -‘ ' - �Ic14iiiIC�.� 4 !�1v thri A t ©d� ri?'�E7 Q �V! 3 i< 5in 1113111111•1•1504 MI WM MS MN tironli t!O DO - ��rv.I0Q_ t70 -Az .re I E=!s s� �.L 1 i' oo v d \ial o 1��, Iv ©- Dom; y' . , ©© n © D s _77 :man !s[71 - X111 5111 -- n',;t> a . aCi6 ,iIIHMI IIkumis gym VII I , NM 11Ii71.�aipr15/4: t v Ap''pp © 0,�' ipp j ®I� M®' , lip lira" Io v Inn Imiagelezidem iv Oro© fr1I4IiIW I A I� .n; lEill i viii1 D1m2 Q t: • • :'u wil O / a .i. 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