COMMON POLICY DECLARATIONS

Policy Number
/fleWBl °
887802
.,Jk SCOTTSD/1LE INSUPANCE coiviwi'ir
Home Office:
CPS0958461
One Nationwide Piaza Columbus, Ohio 43215
Administrative Office:
8577 North Gainey Center Drive Scottsdaie, Arizona 85258
1-800-423-7675
A STOCK COMPANY
ITEM I. Named Insured and Mailing Address
CAmR.OLLW000 V'Ir,LAGE PHAaE III HOA
do GREEMACRE PROPERTIES
4131 DUNN HIGHWAY
TAMPA, FL 33624
Agent Name and Address
YP,NDFF aoOTH
A/O/0 RISK PLACEMENT SERVICES, INC.
18950 N. DALE MABRY HWY AgentNo.: 09005 ProgramNo.: 89
LUTZ, FL 33548
ITEM 2. Policy Period From: 09/24/2008 To: 09/24/2009 Term: 365 DAYS
12:01 A.M., Standard Time at your maiiing address.

Business Description: HOMEOWNERa AS8OCIATION

in return for the payment of the premium, and subject to au the terms of this policy, we agree with you to provide the
insurance as stated in this policy. This policy consists of the following coverage parts for which a premium is indicated.
Where no premium is shown, there is no coverage. This premium may be subject to adjustment.

Coverage Part(s) Premium

Commerciai Generai Liabiiity Coverage Pert $ NOT COVERED

Commercial Property Coverage Part $ 790

Commercial Crime Coverage Part $ NOT COVERED

Commercisi inland Marine Coverage Part $ NOT COVERED

Commerciai Auto (Business Auto or Truckers) Coverage Part $ NOT COVERED

NOT COVERED
Commerciei Garage Coverage Part $

Professionai Liability Coverage Part $ NOT COVERED

58000tt
surplus Uses pgenc James
2400 6. CowmamOI 9l'd # '. $
Address:
Ft LOde'4ae. FLK"IOO 750.00
Ucerrse Nurnber f0 A -.5 Total Policy Premium: $
0
POLICY FEE $ 35 00
1"°°'-jpursuaolt0th5 INSPECTION FEE $ 150.00
- - La'eo- personS
Uses Garners 00 nol SURPLUS LINES TAX $ 46 .75
oltilO F10fl0
109 pnOlOSlOO .94
STIOWPING OFFICE FEE $
195r,a GnaraIH 101 0

ol n snolseol
lot Ins oti
any rqhl ut F000005?
unl,'ar.esi "5
0000

>.
' fJ' ORIOA HURRICANE CAT. FUND $ 9.35
Agenls Counler09080lts EMPA - COMMERCIAL $ 4.00
Form(s) and Endorsement( made a part of this policy at time of issue:
SEE SCHEDULE OF FOR SAND ENDORSEMENTS

10-17-08
KS/NM

THIS COMMON POLICY DECLARATION AND THE SUPPLEMENTAL DECLARATION(S), TOGETHER WITH
THE COMMON POLICY CONDITIONS, COVERAGE PART(S), COVERAGE FORM(S) AND FORMS AND ENDORSEMENTS, IF ANY,
COMPLETETHE ABOVE NUMBERED POLICY.
opsdli . 4 ap
OPS-D-1 (12-00) INSURED
 ) L SCOTTSDALE INSURANCE COMPANYTh
COMMERCIAL PROPERTY COVERAGE PART
SUPPLEMENTAL DECLARATIONS
09/24/2008
CPS0958461 EffectiveDate 12:01 A.M. Standard Time
,6ucyN0.:
09005
CPRROLLWOOD VILLAGE PHASE III HOA Agent No-
[Named Insured:
Item 1. Business Description: HOMEOWNERS ASSOCIATION

Item a Premises Described: SEE SCHEDULE OF' LOCATIONS

Item 3. $500 Deductible unless otherwise indicated.

Item 4. Coverages Provided:

Limit of Covered Coins.
Prem. Bldg. Coverage Insurance Causes of Loss
No. No. 40,000 SPECIAL 80%
1 1 I
TENNIS COURTS

Other ProvIsions
Expires: il Replacement Cost
LI Agreed Value:
Period: Maximum 0 Inflation Guard:
LI Business Income indemnity: Monthly Umit
Extended
LI Reporting
Earthquake Deductible: % Exceptions:
Deductible: 1,000
CONSTRUCTION - MASONRY - N0NCOMBUSTIBLE
Limit of Covered Coins.
Prem. Bldg. Coverage Insurance Causes of Loss
No. No. SPECIAL 80%
7,605
1 1 IRRIGATION CONTROLS
Other Provisions
Expires: j Replacement Cost
LI Agreed Value: 0 Inflation Guard:
Period: Maximum
LI Business Income Indemnity: Monthly Limit
Extended
LI Reporting
Earthquake Deductible: % Exceptions:
Deductible: 1,000
CONSTRUCTION - NONCOMBUSTIBLE
Umitof Covered Coins.
Prem. Bldg. Coverage Insurance Causes of Loss
No. No. 80%
7,605 SPECIAL
1 1 I IRRIGATION VALVES
Other ProvisIons
Expires: Replacement Cost
LI Agreed Value:
Period: Maximum LI Inflation Guard:
0 Business Income Indemnity: Monthly Limit
Extended
LI Reporting
Earthquake Deductible: % Exceptions:
Deductible: 1,000
CONSTRUCTION - NON-COMBUSTIBLE

Item 5. Forms and Endorsements:

time of issue:
Form(s) and Endorsement(s) made a part of this policy at

See Schedule of Forms and Endorsements:

POLICY DECLARATIONS, TOGETHER WITH THE COMMON
THIS SUPPLEMENTAL DECLARATIONS AND THE COMMON COMPLETE THE ABOVE NUMBERED POLICY.
POLICY CONDITIONS, COVERAGE FORM(S) AND ENDORSEMENT(S)
INSURED
cF'S-SD-i (9-00)