STATION SQUARE PARK (08-0007-EN) - BUILDER'S RISK INSURANCE
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The Inland Marine Declarations, Common Policy Conditions,
Commercial Inland Marine Conditions, Coverage Form(s) and
Endorsement(s), if any, issued to and forming a part
thereof, complete the Commercial
Insurance Policy numbered as follows:
[gJNew Policy BR67764185
DRenewal of
DRewrite of
In return for the payment of the premium, and
subject to all the terms of this policy, we agree
with you to provide the insurance as stated in this policy.
1. Named Insured and Mailing Address:
ANGLE & SCHMID INC.
P.O. BOX 40907
ST PETERSBURG, FL 33743
3. Policy Period - From: 07/21/2008 To: 07/21/2009
12:01 a.m. Standard Time at your mailing address above.
INLAND MARINE DECLARATIONS
ASSURANCE COMPANY OF AMERICA
A Stock Company
Administrative Office: 1400 American Lane
Schaumburg, IL 60196
THIS IS A COINSURANCE CONTRACT.
Please read your policy.
2. Producer Information
A) Name:
Morrow Insurance Group
16606 N Dale Mabry Hwy
Tampa, FL 33618-1400
#02122794
B) Telephone #: 813-963-1669
C) Fax #: 813-961-3743
D) Zurich Producer #: 02122794
E) Field Office Name: SOUTHWEST FLORIDA
F) Field Office Code: SB
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ZURICH"
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4. Form of Business: 0 Individual D Partnership IKI Corporation D Joint Venture D Other
5. Limits of Insurance (either One-Shot or Re ortin Form as indicated below
D Reporting Form (continuous policy) ~ One-Shot (non-reporting formlsingle structure policy)
D Annual Rate D Monthly Rate (HBIS - 4) D 1-4 Family Dwelling ~ Commercial Structure
Property Location: NE CORNER OF GARDEN ST. & CLEVELAND
STATION PARK SQUARE
CLEARWATER, FL 33756
A) Anyone structure
B) Property temporarily at any other
premises
C) Property in transit
D) All covered property at all locations
E) DevelopmenUSubdivision
Fences/Walls or Signs
F) Rate
G) Premium
H) Total Taxes and Surcharges
(per attached endorsement)
I) Total Fully Earned Policy Premium
6. Deductible: D $500
$
$
$
$
Per Report
Per Report
Per Report
Per Report
Per Report
New Construction
A) Anyone structure
B) All covered property at all locations
(same as A unless otherwise noted)
Remodeling
C) Renovations and Improvements
D) Existing Buildings or Structures
Additional Coverage & Final Premiums
E) Property temporarily at any other premises
F) Property in transit
G) DevelopmenUSubdivision
Fences/Walls or Signs
H) Rate
I) Premium
J) Total Taxes and Surcharges
(per attached endorsement)
K) Total Fully Earned Policy Premium
(minimum premium applicable)
D $1,000 I&l $2,500 D $5,000 D Other
$
$
1,270,000
1,270,000
$ 0
$ 0
$ 10,000
$ 25,000
$ 0
$ 0.276
$ 3,505.00
$ 171.76
$ 3,676.76
7. Forms Applicable To All Coverage Parts:
U-RET-E-402-A_11-06, IL 1201 (11/85),47681 (09/93), 9H0003 (04/94), U-GU-630-C (12/07), U-GU-766-A (12/07), U-GU-767-A (01/08), U-GU-726-A
(07/06), U-GU-743-A FL (10/06), U-GU-751-A FL (03/07), CM0001 (09/04), ILO (11/98),40471 (11/02), 5), CM0116 (04/89), HBI 20,
HBIS-1 (11/02), HBIS-43 (11/02), HBIS-48 (05/97), HBIS-65 (12/01), IL0175 ( 9/93),IL02 7 , U -76 (07/0), U-GU-773-A (04/08
Countersigned:
By:
FM-170001 (0907)
Policy Change
Numbe~
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
IL 12 01 11 85
POLICY CHANGES
POLICY NO.
POLICY CHANGES
EFFECTIVE
COMPANY
BR67764185
From 07/21/2008 to 07/21/2009 Assurance Company of America
NAMED INSURED
ANGLE & SCHMID INC.
P.O. BOX 40907
ST PETERSBURG, FL 33743
AUTHORIZED REPRESENTATIVE
Morrow Insurance Group
16606 N Dale Mabry Hwy
Tampa, FL 33618-1400
#02122794
COVERAGE PARTS AFFECTED
Builders Risk Coverage
CHANGES
2005 Florida Hurricane Catastrophe Fund (FHCF) Assessment: 1.0% $35.05
2006 Florida Insurance Guaranty Association (FIGA) Emergency Assessment: 1.5% $52.58
2006 Florida Insurance Guaranty Association (FIGA) Assessment: 0.5% $17.53
2007 Florida Insurance Guaranty Association (FIGA) Regular Assessment: 1.9% $66.60
Authorized Representative Signature
GU 269 (11-85)
IL 12011185
Copyright, Insurance Services Office, Inc., 1983
Copyright, ISO Commercial Risk Services, Inc., 1983
Page1 of 1
FLORIDA
HOME BUILDERS INSURANCE SERVICES, INC.
BUILDERS RISK DECLARATIONS
POLICY # BR67764185
EFFECTIVE DATE
07/21/2008
PREMIUM FOR THIS COVERAGE FORM $ 3,676.76
LIMITS OF INSURANCE
LIMITS OF INSURANCE
A.
ANY ONE STRUCTURE
$1,270,000
B.
PROPERTY TEMPORARILY AT ANY OTHER PREMISES
$10,000
$25,000
C.
PROPERTY IN TRANSIT
D.
ALL COVERED PROPERTY AT ALL LOCATIONS
$1,270,000
DEDUCTIBLE
A.
MINIMUM DEDUCTIBLE $500 UNLESS OTHERWISE INDICATED
$2,500
SPECIAL PROVISIONS - IF ANY:
DEDUCTIBLE PROVISION:
The following is added to Section D. DEDUCTIBLE:
The deductible applies separately to each building, if two or more buildings are covered.
9H0003 Ed. 04-94 (One-Shot)
(May Be Reproduced)
~t.~;:;;:;~- 813-830-7871 To: JERRY SCHMID
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Dale: 7/18/2008 Time: 12:04:52 PM
Page 2 of 3
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THIS IS EVIDENCE THAT INSURANCE AS IDENTIFIED BElow HAS BEEN ISSUED, IS IN FORCE, AND CONVEYS ALL THE
RIGHTS AND PRIVlLEGES AFFORDED UNDER THE POll 'Yo
PROOUCER 1:::=:" 81}-963-1669 181 -961-374 COMPANY
MORROW INSURANCI!i GROUP l
LENORAC. OLNEY/A196064 f.
16606 NORTH DALE ~RY HIGHWAY
CARROLLWOOD P'L 33618
Suzanne Barnett
CODE,
DATE (MMlDDIYY]
07/18/08
!!J
,~ ACORD.
ZURICH INSURANCE COMPANY
5011 GATE PKWY '150
JACKSONVrLLE PL 32256
SUB CODE:
CUSTOMERID#: ANGLE-l
INSURED
I.
.'-T'"
LOAN NUIIBER
POl.JCY NUMBER
ANGLE &: SCHMID, mc
P.O. BOX 40907
S~. PETERSBURG FL 33743
EFFECTIVE DA IE
BR 67764185
EXPlRAl10H DAn:
CON'mUED UNTIL
TERMINATED IF CHECKED
07/21/08 07/21/09
THIS REPLACEs PRIOR ~ENCE DATED:
i
1:
I: C:Iri' 01" CLEARWATER
'S'l'RBBT SCAPE
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LOCA nO~ESCRlPT1ON
001
NB CORNER OF GARDEN/CLBVBLAND
CLEARWATER li'L 33576
STAnOH PARK SQUARE
DEDUCnBLE
BUILDERS RISK - LOCATION 001
WIND DEDUCTIBLE 3 %
$1,270,000
$2,500
, ~I- ._-~.
SUB -CONTRACTORS AS ADDITIONAL INSURED ~ THEIR INTEREST MAY APPEAR AS
PER PAGE 17 OF 19 I~EM #11 COlSITAJ:NBD * 'l'HE POL:ICY.
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ll-iE POLICY IS SUBJECT TO THE PREMIUMS. FORMS. AND RULES IN EFFECT FOR EACH POLICY PERIOD. SHOULD ll-iE
POUCY BE TERMINATED, THE COMPANY WILL GIVE THE!!AoomoNAL INTEREST IDENTIFIED BELOW 30 DAYS
WRITTEN NOTICE, AND WILL SEND NOTIFICATION OF Mf CHANGES TO THE POLICY THAT WOULD AFFECT THAT
INTEREST, IN ACCORDANCE WITH THE POLICY PROVISI : NS OR AS REQUIRED BY LAW.
J!- --.,...
CITY OJ! CLEARWATER
MUNICIPLE SERVICES BLDG
100 SOUTH KYR'l'LE AVE
CLEARWATER FL 33755
ADIlmONAL INSURED
NAME AND ADDRESS
I,
Aq;:;;;;;;;Q}JMt2If
..."" SUzanne 813-830-7871 To: JERRY SCHMID
Date: 7/18/2008 lime: 12:04:52 PM
Page 3 of 3
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Policy Change n
Numbe~ .1 /1
THIS ENDORSEMENT CHANbES THE POlley. PLEASE READ IT CAREFULLY.
~ fL12 011185
"
!POLICY CHANGES
I:
POUCY NO.
BRsnS4185
NAMED INSURED
ANGLE & SCI:1MID INC.
P.o. BOX 40907
ST PETERSBURG, FL 33743
. COVERAGE PARTS AFFECTED
Builders Risk Coverage
~OUCY CHANGES
IfFFECTIVE
Fkm 07/21/2008 to 07/21/2009
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COMPANY
Assurance Company of America
AUTHORIZED REPRESENTATIVE
Morrow Insurance Groop
16606 H Dale Mabry Hwy
Tampa. FL33618-1400
#02122794
CHANGES
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The rollowlng chllllg8S were made to the policy: I
Additional PrenOOm: $0_00 ~
Total policy premium is uncl1anged: '3,676.76 E
The rollowing changes have been made to the 8d+nallnterests:
I!
Added Additional Insured - Other as follows: f,
CITY OF CLEARWATER ':
MUNICIPLE SERVICES BLDG II:
100 SOUTH MYRTlE AVENUE "
CLEARWATER, FL33755 I;
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C~ht, 1rJ$UIaOCG Services Oflice. Inc.. 1963
Copyri~t. ISO commercial Risk SeMces. Inc.. 1963
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GU 269 (11-85)
IL 12 01 11 85
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