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' The Inland Marine Declarations and INLAND MARINE DECLARATIONS •Y1°": """u" Endorsement, if any, issued to form a part thereof, completes the Commercial I Insurance Policy numbered as follows: BR 48548003 ZURICH ® New Policy ASSURANCE COMPANY OF AMERICA ❑ Renewal of NEW YORK, NEW YORK 10038 ❑ Rewrite of A Stock Company ' In return for the payment of the premium, and subject to all the terms of this 2. Producer Information (complete A-E) policy, we agree with you to provide the insurance as stated in this policy. A) Name: THIS IS A COINSURANCE CONTRACT. Please read your policy. Halcyon Underwriters, Inc. 1 . Named Insured and Mailing Address : 2600 Lake Lucien Drive, Ste. 304 Barth Construction, Inc. Maitland , FL 32751 ' 1717 Indian River Blvd., Suite 202A B) Telephone #: 4076601881 Vero Beach, FL 32960 C) Fax #: 4076600525 3. Policy Period — From Effective Date Of: 02 23 2004 D) Zurich Producer #: 02219582E) Field Office Name : ORLANDO to (check one): ❑ Continuous Reporting ® One Year From Effective Date F) Field Office Code: ZO 12 :01 a.m. Standard Time at your mailing address above. 4. Form of Business: ❑ Individual ❑ Partnership IN Corporation ❑ Joint Venture ❑ Other 5. Limits of Insurance (select either One-Shot or Reporting Form option below) ❑ Reporting Form (continuous policy) ® One4hot (non. reportingform/single structure policy) HBIS-1 ❑ Annual Rate ❑ Monthly Rate (HBIS•4) ❑ 1 -12 Family Dwelling ® Commercial Structure r ❑ Including Existing Building or Structure (HBIS-37) ❑ Including Existing Building or Structure (HBIS-37) Property Location 9450 C.R. 512 A) Any one structure` $ 1 ,500,000 Sebastian FL 32958 B ) Property temporarily at A) Anyone structure any other premises $ 10, 000 B) Property temporarily at C) Property in transit . $ 25,000 any other premises $ 10 , 000 D) All covered property C) Property in transit $ 25,000 ' at all locations $ 5,000,000 D.) All covered property at all locations (same E) Development(Subdivision Fences/Walls as A unless otherwise noted) $ _ 1 .356, 115 or Signs Per Report E) Development/Subdivision Fences/Walls or Signs $ 167.257 F) Rate Per Report F) Rate $ 0 .35 G) Premium Per Report G) Premium $ _ 5 , 332 .00 H) Tax (applicable in KY only) Per Report H) Tax (applicable in KY only) $ 0 .00 1) Total Fully Earned Policy Premium Per Report 1) Total Fully Earned Policy Premium $ 5 .332 .00 Subject to underwriting guidelines (minimum premium applicable) 6 . Deductible (minimum $500 unless otherwise Indicated): 99 $ 1 , 000 ❑ $2,500 ❑ $5, 000 ❑ Other. 7 . Forms Applicable To All Coverage Parts: . ' E 40471 Builders Risk Coverage Form IN HBIS-42 Florida Fraud Statement E 47681 Comm. Inland Marine Coverage Part ® HBIS-43 Windstorm Percentage Deductible ® CM0001 Comm. Inland Marine Conditions ❑ HBIS-44 New York Fraud Statement E IL0017 Common Policy Conditions (ILI in WA) Other Forms: (list other applicable state and/or HBIS ' ® HBIS-58 Development/Subdivision Walls/Fences/Signs forms; all required state forms applicable) ® 9H0003 Florida Builders Risk Declarations 1aRIR - 4A rmol n1. II 0175 HRIRF;R 11 ng5g- ❑ HBIS-35 Windstorm or Hail Exclusion ❑ HBIS-37 Existing B Iding (s) or Structure(s) Countersigned. _ � a 0 /6 1 ' ate Y D FM 170001 Rev. 07/00 Authori d epresentative INSURED COPY MORTGAGEES COPY AGENT COPY BUILDERS RISK PLAN COPY f