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ZS/ American Safety Indemnity Company <br /> 100 Galleria Parkway SE, Atlanta GA 30339 <br /> 8004884647 FAX 770 -955 -8339 <br /> �,,, E&S Fax Number (770) 955 -6163 <br /> AMENC.APISAFETYINSURANCE .: .. .1Si . e l ,: <br /> s u`yiiKAr LIChC ';:lirri*fg <br /> ttta <br /> POLICY uc.n Yr . <br /> NUMBER: 156AUI 84657 -00 ` •:;; rxia'I ` }t 'i'n' Cl <br /> COMMERCIAL GENERAL LIABILITY DECLARATIONS <br /> Broker - Appalachian Underwriters, Inc. Producer - INSURANCE SOURCE COM <br /> 1Nt: <br /> Named Insured: GTB BUILDERS LLC <br /> Mailing Address: 360 BLANCA AVE, Tampa FL 33606 <br /> Policy Period: From: 12/21/2010 To: 12/21/2011 <br /> At 12:01 A.M. Time at your Mailing Address Shown Above <br /> IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF <br /> THIS POUCY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THE <br /> POLICY. <br /> ti <br /> LIMITS OF INSURANCE <br /> Each Occurrence Limit $ 1,000,000 <br /> Fire Damage Limit - Any one fire $ 100,000 <br /> Medical Expense Limit - Any one person $ 5,000 <br /> Personal & Advertising Injury Limit - Any one person or organization $ 1,000,000 <br /> General Aggregate Limit $ 2,000,000 <br /> Products/Completed Operations Aggregate Limit $ 2,000,000 <br /> DESCRIPTION OF BUSINESS <br /> FORM OF BUSINESS <br /> ❑Individual <br /> CD Partnership ❑Joint Venture <br /> p Limited Liability Company ❑ Organization, Including a Corporation (but not including a <br /> Partnership, Joint Venture or Limited Liability Company) <br /> Business Description: GENERAL CONTRACTOR <br /> IN CONSIDERATION OF THE PAYMENT OF THE PREMIUMS, AND SUBJECT TO ALL THE TERMS, CONDITIONS AND <br /> EXCLUSIONS OF THIS POLICY, WE AGREE TO PROVIDE THE INSURED WITH THE INSURANCE AS STATED IN THIS POLICY. <br /> THESE DECLARATIONS TOGETHOR WITH THE COMMON POUCY CONDITIONS, COVERAGE FORM(S) AND ENDORSEMENTS <br /> ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE REFERENCED POLICY. <br /> Page 1 of 3 <br /> g'd d6Z :Z0 L L LZ uef <br />