4-Point Inspection Personal Lines
(Edition 9/2012)
Citizens Insp4pt 09 12 Page 1 of 3
This form has been made available to verify the types, ages and conditions of a home’s four major systems to determine
eligibility/acceptability with Citizens Property Insurance Corporation.
If another inspection form is used, it must provide the same level of detail as found on this report.
INSURED/APPLICANT NAME
APPLICATION / POLICY #
ADDRESS INSPECTED:
ACTUAL YEAR BUILT:
DATE INSPECTED:
Minimum Photo Requirement:
Front elevation Rear elevation
Open Main Electrical Panel and interior door
HVAC heating systems equipment (with dated manufacturer’s plate)
ALL hazards or deficiencies noted in this report.
A Florida-licensed inspector MUST complete, sign and date this form.
ELECTRICAL SYSTEM (*SEPARATE DOCUMENTATION OF ANY ALUMINUM WIRING REMEDIATION MUST BE PROVIDED
AND CERTIFIED BY A LICENSED ELECTRICIAN)
Age of Main Panel:
Year Last Updated:
Total Amps:
Wiring Type
Romex, BX, or
Conduit:
Active Knob & Tube
or cloth wiring:
Aluminum*:
Other (specify):
_________
Main Panel Amps
Less than 60 A
Fuse
60A Fuse
100A Fuse
100A CB
200A CB:
Other (specify):
_________
Panel #2
Less than 60A Fuse
60A Fuse
100A Fuse
100A CB
200A CB:
Other (specify):
__________
Hazards Present
Blowing Fuses or
Breakers
Empty Breaker
Sockets
Loose Wiring
Improper
Grounding
Over Fusing
Hazardous Panel
Double Taps
Exposed/Unsafe
Wiring
Other (explain)
* If single strand (aluminum branch) wiring,
provide details of all remediation. Separate
documentation of all work must be provided
and certified by a licensed electrician.
Entire home rewired
with copper
Connections repaired
via COPALUM crimp
Connections repaired
via AlumiConn
Is the electrical system in good working order? Yes No (explain)
Use the Additional Comments/Observations Section below to provide full details of all updates, hazards, etc.
HEATING SYSTEM
Age of System:
Year Last Updated:
Central HVAC
Yes No
Are the heating, ventilation and air
conditioning systems in good
working order?
Yes No (explain)
Hazards Present
Wood Burning Stove
or central gas
fireplace not
professionally
installed?
Space heater used
as primary heat
source?
Yes No
Yes No
If not central,
indicate primary
heat source and fuel
type:
Is the source
portable?
___________
___________
___________
Yes No
Use the Additional Comments/Observations Section below to provide full details of all updates, hazards, etc.
4-Point Inspection Personal Lines
(Edition 9/2012)
Citizens Insp4pt 09 12 Page 2 of 3
This form has been made available to verify the types, ages and conditions of a home’s four major systems to determine
eligibility/acceptability with Citizens Property Insurance Corporation.
If another inspection form is used, it must provide the same level of detail as found on this report.
PLUMBING SYSTEM
Age of System:
Year Last Updated:
Deficiencies (check all that apply):
Type of Pipes
Copper:
PVC:
Galvanized:
Polybutylene:
Other (specify):
_________
Is the plumbing system in good
working order?
Yes No
Active leak
Indication of prior leak(s)
Connections/Hoses leaking
or cracked
Water Heater (explain)
Other (explain)
Use the Additional Comments/Observations Section below to provide full details of all updates, hazards, deficiencies, etc.
ROOF - WITH 2 ROOF PHOTOS, THIS PORTION CAN TAKE THE PLACE OF THE ROOF CONDITION CERTIFICATION FORM (CIT RCF-1)
Age of Roof
(years):
____________
Predominant Roof
Covering Material:
____________
Roof Useful
Remaining Life:
____________
Date of Last
Update:
Date of Last Roofing
Permit:
If updated
(check one):
Full Replacement
Partial
Replacement
% of Replacement
____________
Any visible signs of
damage/deterioration?
(e.g. curling/lifted/
loose/missing shingles
or tiles, sagging or
uneven roof deck)
Any signs of visible
leaks?
Yes No
Yes No
Overall Condition of Roof:
Excellent
Good
Fair
Poor (explain)
Use the Additional Comments/Observations Section below to provide full details of all updates, hazards, etc.
ADDITIONAL COMMENTS OR OBSERVATIONS:
I CERTIFY THAT I PERSONALLY INSPECTED THE PREMISES AT THE LOCATION ADDRESS LISTED ABOVE ON THE INSPECTION DATE NOTED.
I CERTIFY THAT THE ABOVE STATEMENTS ARE TRUE AND CORRECT.
INSPECTOR SIGNATURE
TITLE
LICENSE NUMBER
DATE
click to sign
signature
click to edit
4-Point Inspection Personal Lines
Special Instructions
Citizens Insp4pt 09 12 Page 3 of 3
This form has been made available to verify the types, ages and conditions of a home’s four major systems to determine
eligibility/acceptability with Citizens Property Insurance Corporation.
If another inspection form is used, it must provide the same level of detail as found on this report.
A 4-Point Inspection is required for all homeowner, dwelling and mobile home
applications for properties over 30 years old.
The Citizens 4-Point Inspection form includes the minimum data needed for Underwriting to properly
evaluate a property application. While this specific form is not required, any other inspection submitted for
consideration must include at least this level of detail to be acceptable to Citizens.
PHOTO REQUIREMENTS
Photos must accompany each 4-Point inspection submitted to Citizens. The minimum photo requirement
for all submissions is a front and rear elevation. However, there are additional photo requirements for a 4-
Point inspection such as:
Open Main Electrical Panel and Interior Door
HVAC heating system (with dated manufacturer’s plate)
ALL hazards or deficiencies noted
ROOF REQUIREMENTS
The Citizens 4-Point inspection may be submitted in lieu of the Citizens Roof Condition Certification Form
(CIT RCF-1) if a minimum of 2 photos of the roof are also provided. This will satisfy the required roof
documentation listed in the Citizens Rules Manual.
INSPECTOR REQUIREMENTS
All inspections must be performed (and certified) by the appropriately Florida-licensed professional.
Without a verifiable, certified inspector’s dated signature, the documentation will not be accepted. The
following FLORIDA-LICENSED individuals may complete a 4-Point Inspection for Citizens in its entirety:
Note: A trade-specific, licensed professional may sign off only on their trade component of the 4-Point
inspection form (e.g., a roofing inspector may sign off only on the roofing portion of the form).
A general, residential, or building contractor
A building code inspector
A registered architect
A home inspector
A professional engineer
A building code official who is authorized
by the State of Florida to verify building
code compliance
CERTIFYING THE CONDITION OF EACH SYSTEM
The Florida-licensed inspector is required to certify the condition of the electrical, HVAC and plumbing
systems. “Acceptable Condition” means that each system is working as intended and there are no
visible hazards or deficiencies.
ADDITIONAL COMMENTS OR OBSERVATIONS
This section of the 4-Point inspection must be completed with full details/descriptions if any of the
following are noted on the inspection:
Updates (provide full details of the types of updates
completed, date completed and by whom)
Any system determined to be NOT in good
working order.
Any hazards/deficiencies are present
NOTE TO ALL AGENTS
The writing agent must fully review each 4-Point inspection submitted with an application for coverage in
advance. It is the agent’s responsibility to ensure that all Citizens rules and requirements are met before
the application is bound.
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