Backup Documents 06/12/2022 Item #16D10 16. J f
ORIGINAL DOCUMENTS CHECKi,IST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pints paper, Attach ill 11ri4in,d durmncui. the completed routing dip and original documents are to he furmirdcd lu Ilic(mull Alto rrlcy Wee
al the time the item is placed on the m enda, •1t1 eumplrlcd routing slip,and original documents must he received in the County my Attorney(lfli ec no later
than londay preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines 111 through 112 as appropriate for additional signatures,doles,and/or information needed. lithe document is already complete wi th the
exception of the Chairman's signature,draw n line through routinpilines p I through$2,complete the checklist and forward to the Cot -Attorney urn cc. _
Route to Addressee(s)(List in routing order) Office initials Date
1. Lisa N. Carr CIS Inc 10/12/2022
2. Derek Perry County Attorney Office
Dvr /GI/'I/2 Z
3. BCC Office Board of County N/A N/A
Commissioners
NOTE: Clerk's attestation is not required.Please do not route this item to Clerk's Board Minutes and
Records.CAO please scan document after execution by Chairman and email them to Clerk's Minute
and Records for its records.
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Lisa N.Carr,Senior Grants Coordinator Phone Number 239-252-2339
Contact/ Department CHS
Agenda Date Item was June 12,2012 Agenda item Number 16D10
Approved by_the BCC
Type of Document Insurance Claim Check Endorsement for: Number of Original y 2 CH E LKS
Attached Bruce A.Batelaan —ADVAr((f Pry.,rrterr Documents Attached
PO number or account n/a n/a n/a
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? Yes
2. Does the document need to be sent to another agency for additional signatures? If yes, N/A
provide the Contact Information(Name;Agency;Address.Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be N/A
signed by the Chairman,with the exception of most letters,must be reviewed and signed
_ by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the N/A
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's N/A
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip N/A
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 06/12/2012 and all changes made during
the meeting have been incorporated in the attached document. The Countyper
Attorney's Office has reviewed the changes,if applicable. ^",
9. Initials of attorney verifying that the attached document is the version approved by the
BCC,all changes directed by the BCC have been made,and the document is ready for the 0O r
Chairman's signature. ---.....__. — `'"r
l Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
— - ---- i 6 p 1 p
Collier County
Community and Human Services Division (CHS)
Homeowner Insurance Check Endorsement Policy
Collier County has provided purchase assistance and/or rehabilitation assistance to income
qualified recipients.As long as the recipient continues to own and occupy the assisted property
during the term of the mortgage/lien,then the loan will not have to be repaid.
On occasion,the recipient may file a property insurance claim with their homeowner insurance
company for damages to the assisted property and receive money to make the repairs.If the
insurance claim check is made payable to the homeowner and Collier County,then the
homeowner can request in writing that Collier County endorse the check for deposit in order to
pay for the repairs.
The following documents must be provided to CHS at the address below for check
endorsement consideration:
1. Copy of Homeowner's current insurance policy-Declaration Page. Pi"G J,cl&( C.i..W rC- t`,t„I kiL,ty
2. Copy of insurance company's claim report with worksheet including description of
repairs and costs. C.1c;,nn 1. 0 Pita.,S`,), 1-1-‘1 S t. «v‘ a VI A c:.t, PrOf ol1e►L4-
Copy of photos of claim damage.
4(Copy of Insurance check(s)payable to homeowner, first lien holder and Collier County.
Homeowner Name: R)ikv.ct v1. --..3):03 TV:L-4wt..%
Homeowner Address: 1 C 9.C: 5 l:vi...'a Du_+ t.
Primary Contact Number: <LL •2 3 t 6 �i 2- 65 l
Homeowner Email: k T et;2 C ►-i C'► r—,w,L L . cc,.
.....F` t s�J.1,4 J N. 4-- �--v-- %�i12/k,yZ... Reviewed
CH -Grant Coordinat rDate
(,2/�' e-el-1 a) I,3 `"? Approved
CS Dit' ec Date Denied
I6D10
American Strategic Insurance Corp.
P.O.Box 33018
St.Petersburg,FL 33733-8018 =u ; agg: Nwt
866-511-0793
FloodUnderwriting@asicorp.org
Renewal Dwelling Policy Form Policy Declarations
Policy Number: 00FLD39667 Policy Period: 11/30/2022 to 11/30/2023
Product Type: Standard Policy At the time of loan closing
Endorsement Effective: 11/30/2022
Named Insured NAIC: 10872 Agent/Producer Name&Address
BRUCE BATELAAN 429404-KINGDOM TREE INSURANCE GROUP,LLC
Property Location: 113 SOUTH MONROE STREET,1ST FLOOR
1020 GUAVA DR , f TALLAHASSEE,FL 32301
NAPLES,FL 34104-4418 YY (850)201-7255
Mailing Address Payor: BRUCE BATELAAN
1020 GUAVA DR
NAPLES,FL 34104
Building Information
(Date of Construction:01/01/1962 Occupancy: Single Family
Rate Category:Rating Engine Elevated Building: No
Number of Floors: 1 Floor
Built on Slab at Ground Level
Construction Type: Frame
First Floor Height: 0.6 ft Elevation Certificate
Prior NFIP Claims: 0
Your property's NFIP Flood claims history can affect your premiu
Primary Residence:No
Coverage Information Limit(s): Deductible Premium
Building $200,000 $2,000 $3,259.00
Contents $24,000 $2,000 $864.00
r_ ICC Premium: $75.00
I'HLLSISNOTA.BILL. Mitigation Discount: $0.00
MORTGAGEE: CRS Discount: $-19.00
The Reform Act of 1994 requires you to notify the WYO Full Risk Premium: $4,282.00
company for the policy within 60 days of any changes in the Annual Increase Cap Discount: $2,667.00
service of the loan. Pre-FIRM Discount: $0.00
Newly Mapped Discount: $0.00
COVERAGE LIMITATIONS MAY APPLY. Other Statutory Discounts: $0.00
See Your Policy Form for Detail Discounted Premium: $1,615.00
For questions about your flood in surance policy rating Reserve Fund Assessment: 291.00
HFIAA Surcharge: $250.00
contact your agent or insurance company.To learn more about Federal Policy Fee: $47.00
your flood risk please visit F1oodSmart.gov/floodcosts. Probation Surcharge: $0.00
\optionally Rated:PRE Total Annual Payment: $2,203.00 f
Special Provisions
This policy covers only one building.If you have more than one building on your property,please make sure each is covered. See
Section III Property Covered within your flood policy for the NFIP definition of'building'or contact your agent,broker or insurance
Forms and Endorsements This Declarations Page,in conjunction with the policy,constitutes your Flood Insurance Policy.IN
ASI FLD IMPINF 08,DW 10 2021 Merged WITNESS WHEREOF,we have signed this policy below and hereby enter into this Insurance
Date: 10/10/2022 Kevin Milkey
Executive Vice President,American Strategic Insurance
NFIP STD DP 10 21
16010
Mortgagee(s)
First Mortgagee:
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS CHS DIVISION
3339 TAMIAMI TRAIL E LOAN#:
211 ESCROW:NO
`NAPLES,FL 34112
NFIP STD DP 10 21
nuagiubi
ram-worm PROGREffliff
PO Ban WM
PerniatatFLO,'O
Flood Renewal Premium Notice
411432
Seiniot#deiSW Florida
1721 Sao Mon Mead Ste D
Savo idenE FL 3414S
(231,11424200
POLICY NL 3IIER: FLD201147 POLICY TYPE: STD
NOTICE DATI 11412020
POLICY BOLDER: UUCE BATELAAN
FROPERT'I LOCATION: 1020 GUAVA DE NAPLER,FL 341044411
POLKY ENPIRATION DATE meow.
Don hkc?hhlder.
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bra*/ Geneses Eels coaare Pratriart►
A. CM'RRE.\TCO4"EEAGE 111-50S.00 72.300* 203.00 2.000.00 1.i3100
E MEEASED COVERAGE I/MO .00 23.310�
e. . _ LOOM 2 tDOQOQ I p#.00
Pea or: nnu THIRD BANK ISAOA.ATIMA
!A.BOX 391197
S tON,OH 4413,4107
Lon il:11414057123
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Find Roee..el Node*
Plisse Oink no O en Iatiai.ia0 payment annu: 4 > FLp39ed7
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rein mann of the entrap �
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PROGRESSIVE
FL UUO
P.O. Box 33018
St.Petersburg,FL 33733
(866)511 —0793
Fax(888)308—9025
floodclaimsAasicoro.orq
October 3, 2022
Dear Policyholder,
On behalf of Progressive,we are sorry for your recent flood loss and hope that your flood insurance policy
through the National Flood Insurance Program will help you recover as quickly as possible. We have
enclosed your requested pre-inspection advance payment(s). Please be aware, by accepting the enclosed
advance payment check(s)you agree to and acknowledge the following:
1. The NFIP advance payment is not intended to provide reimbursement to the policyholder for non-
SFIP insured expenses, such as costs related to evacuation, temporary housing while the home
is non-inhabitable, a rental car to cover the loss of a personal vehicle, or any other expense not
insured by the SFIP.
2. The issuance and acceptance of an advance payment does not prejudice or waive any
claim or defense available to either the policyholder or insurer.
3. The issuance and acceptance of an advance payment does not constitute an admission
of coverage under the policy.
4. The policyholder must assert the insured property has suffered a insured loss.
5. If the insurer determines the claim is not a insured loss,or if the advance payment
exceeds the amount of the insured loss, the policyholder is ineligible for the payment and
agrees to repay the advanced payment in excess of the insured loss.
6. Acceptance of an advance payment will not affect the policyholder's right to seek
additional payment under the terms and conditions of the SFIP.
7. After the claim is settled, the insurer will reduce the final payment by the amount of any
advance(s)payment made to the policyholder.
8. Building coverage only: the insurer must include as co-payee any mortgagee shown on
the Declaration Page of the policy or any known mortgagee on any advance payment for
building coverage.
9. To finalize the claim, the policyholder must execute a proof of loss meeting the
requirements of the SFIP for all amounts received, including the amount of the advance
payment, except as may otherwise be authorized by the Administrator under any
applicable waiver.
Please stay safe—you may contact the Flood Claim Department if you have any questions or concerns
regarding the enclosed advance check(s)or the flood claim process.
Flood Claims Department
Progressive Home
Phone: 866-511-0793
•
Progressive Flood
P.O.Box 33018 St.Petersburg,FL 33733
(866)511 —0793 Fax(888)308—9025
floodclaimstu'�.asicorp4rq
floodclaims@asicoro.orq
1 60 1 U
4
AMERICAN STRATEGIC INSURANCE 68307
BRUCE BATELAAN AND COLLIER COUNTY BOARD OF
COUNTY COMMISSIONERS CHS DIVISION
1020 GUAVA DR
NAPLES, FL 34104-4418
6MEFKANKPWG.,IC,Ak§...-UWICE,A, .t.cE,TrinNNsi,16„BE0),N_,,o*H
sg..ftvit„.GER;ByvEz--14 „:. , ,4% • -4 •a„.,'
St".4 Z4ii" Zi; 2 A§LIvA171 n sr4-EtR§AUtV3703 ttgt 41;:i
SOO PEitROUR*Fa342
-71
..z- r
V:, 0 41 RFV.t, AV fr's 4.i 431
IA 4,-4!. tv ioo
'471r- alt.V* ‘tt ,, .‘
1803/-221Ow " • DATE AMOUNT
10/3/2022 $5,000.00
EA, „tits• ir Z.P."4-;;;A:;.:xtz„ ;
1,!? kit7 <*,
—AO-ft d kid Nit
n ottO
F.t...5-4.1.,UCEPATEI-AAN;VM eptfvER am rffy,4304Rwicazt% VOID SIX MONTHS FROM CHECK DATE
rr&R 00uNTY-'0:40MmisstoO pi S s Divi_stONtg m
4,••
SS'
NAPLES, FL 34104-4418
7.* :z1P -513
111 68 30 7 111 1:08 2 90 2 7 5 7I: L 0 2 3 7 1 4111
AMERICAN STRATEGIC INSURANCE 68307
BRUCE BATELAAN AND COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS CHS
DIVISION
18037-221001
ADVANCE PAYMENTDwelling for Stream, River or Lake Overflow loss occurring 9/28/2022 12:00:00
AM
1601-
AMERICAN STRATEGIC INSURANCE 68627
BRUCE BATELAAN AND COLLIER COUNTY BOARD OF
COUNTY COMMISSIONERS CHS DIVISION
1020 GUAVA DR
NAPLES, FL 34104-4418
AMERICAN STRATE$IQ INSURANCE w CEyTENNIAL BAF'1K,,, �,,, ')
BERM€E48Y INS'�1 z' % 48 fig4 S1 tE NORTH � � 6 �O ��/ z
� VI 2'ASI AIAY' ' eST E: StiuF36 Fi 33703 a y
5<.
tt4 = m#: SAfN;f PEtIiRSBURO F gb2 ; ,;• C .` �; 'f ;
18037-22'1001 DATE AMOUNT
10/9/2022 $10 000.00
� � '
PAID"- 2 1 qusand Dcf#ars�A ��{±N, C�nI�" " .�r+#«,�. . .. rr f
'.o?a. a. ';..:,.:.: 1 "'P"y. t x.?,. ewe ' r-�.
1 RUCE A ELM AND s O.L ER U 1'D RD OkB VOID SIX MONTHS FROM CHECK DATE
"SR 1i :`v CQUNTGtMMISS�IONERS CIS D .I®N a
F . �U20 GUAVA DF<:..r .<,,.f< 't1V " f.10-:,:x ` M : E-`4
NAPLES, FL 34104-4418 /wJ♦� >'42tcr-
II'68627 II' 1:013 290 2 7 5 7': L0237LIon
AMERICAN STRATEGIC INSURANCE
68627
BRUCE BATELAAN AND COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS CHS
DIVISION
18037-221001
ADVANCE PAYMENTDwelling for Stream, River or Lake Overflow loss occurring 9/28/2022 12:00:00
AM