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11 ! 11 / 04 THU 13 : 21 FA-1 3213534523 J W Edens Agency 0003 i FretuM nd Marine Declarations and INLAND MARINE DECLARATIONS `— ment, if any, Issued to forme ( �%Nmas "`" """ Partreof, 1�mpletes the Commercial " 19 e Policy numbered as follows : BR 60492628 i `-== C •p ZURICH Poliicy ASSURANCE COMPANY OF AMERICA ewal of NEW PORI(, NEW YORK 10038 rite ofA Stock Company for the payment of the premium, and subject to all the terms of this 2 . Producer Information (complete A- E ) , e agree with you to provide the insurance as stated in this policy. THIS IS A COINSURANCE CONTRACT. Please read your policy. A} Name : I . Named insured and Mailing Address : J • W Edons & Company, Inc. The Watauga Company 758 Country Cluj Drive 4275 Capron Road Titusville, FL 32780 B) Telephone #: 321 -383-4554 Titusville , Fl. 32780-6554 C) Fax # : 321 -0 : 83=4523 3 . Policy Period – From Effective Date Of: 11 i 1 2004 D) Zurich Producer #: 12782900 to (check one): ❑ Continuous Reporting E) Reid Office One Year From Effective date F) Field Office Coder SD SOUTHEAST FLORIDA 12 :01 a . m. Standard Time at your mailing address above. 4. Form of Suslnes3: 0 Individual ❑ Partnership 3 Corporation ❑ Joint V3rture 5. Limits of Insurance (select either One-Shot or Reporting Form option below) Other ❑ Reporting Form (continuousolio P Y) 9 One -Shot (non-reportinll formisingle structure policy) HBIS-1 ❑ Annual Rate ❑ Monthly Rate (HSIS4) O 1 ' 12 Family Dwelling 91 Commercial Structure ❑ including Existing Building or Structure (HBIS-37) ❑ including Existing Buiidi lg or Structure {HB15�7) A) Any one structure' 11500, 0007 Property Location 8900 54th Avenue B ) Property temporarily at $ 1 , SOQ, 000 Sebastian , Fl. 326158 any other premises A) Any one structure $ _ 100 .000 C ) Property in transit $ 10 , 000 8 ) Property temporarily at $ 25, 000 an other remises D} All covered property C) Property in $ 10 ; 000 at all locations $ 5 ,000,000 D ) All covered Property $ 25 , 000 E) DeveiopmenVSubdivisicn Fences/Walls at all locations (same or Signs as A unless otherwise rioted ) $ ` X00 000 Per Report E) Development/Subdivision Fences/Walls L F) Rate or Signs $ ` l G) Premium Per Report F ) Raate 0 H} Tax (applicable In KY only) Per Report G) Premium $ _�00 Per Report H) Tax (applicable in KY only) $ 0.00 Total Fully Earned Policy Premium Per Report 1 ) Total Fully Earned Policy Premium $ Subject to undenn hVhg guidelines — (minimum premium applicable) 350. 00 6 . Deductible (minimum $WO unless otherwise Indicated): 99 $ 1 rODO ❑ $2, 500 ❑ $5, D00 "rJ Other . 7 . Forma Applicable To All Coverage Parts : M 40471 Builders Risk Coverage Form 1047681 Comm . Inland Marine Coverage Part ® HBIS-42 Florida Fraud Statement ® Comm . Inland Marine Covera ns 13 HBIS-43 Windstorm ; 'ercen :age Deductible ® 11_0017 Common Policy Conditions ( IL0146 in WA) E3 HBiS-44 New York Fraud Statement El Development/Subdivision Walls/Fences/Signs forms ; all required state forms aOther Forma: (list other arms a plicable) state andlor HBIS 9 9H0003 Florida Builders Risk Declarations ppl ❑ HBIS-35 Windstorm or Hall Exclusion HRIS- ate fin_�Tr� IZ5 0A--- Rrs�S c^ rlant � ❑ HBIS-37 Existing Buildlyal's ) r Structure(s ) J�lsd7 tI "r � I_ � � Countersigned : . / Date BY• C� i=lam FM 170001 Rev. 07/00 Author] k Representative INSURED COPY MORTGAGEES COPY AGENT COPY BLILL )ERS FJSK PLAN Copy