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DEMO-12-2375
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 183033 Permit Number: DEMO -12 -12 -2375 Scheduled Inspection Date: January 03, 2013 Inspector: Bruhn, Norman Owner: , BARRY UNIVERSITY Job Address: 11300 NE 2 Avenue LaVoie Hall Miami Shores, FL 33138 -0000 Project: BARRY UNIVERSITY Contractor: COTTON USA LP Permit Type: Demolition Inspection Type: Final Work Classification: Building Phone Number Parcel Number 1121360010160 -12 Phone: (712)849 -9300 Building Department Comments DEMOLITION OF EXTERIOR DRYWALL Infractio Passed Comments INSPECTOR COMMENTS False passed YIl j /� /? [6 � Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments January 02, 2013 For Inspections please call: (305)762 -4949 Page 16 of 26 1411/112 slu(,L. Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: B Permit No. 'BC 20 EC 17 Master Permit No. G ROOFING It 342c:' 2 11° �, - M $ A. -t ttCiwe'es_S JOB ADDRESS: (} S OE, 14 7 Cc a u tit �'t 3 �'� L( t(( t 114L ) City: Miami Shores County: Miami Dade Zip: 3 31 4. 4 Folio/Parcel #: Is the Building Historicafy Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): 1130,) 1. . 2- y4 Phone#: Address: k� City: State: Zip: Tenant/Lessee Name: Phone#: Email: tk 4r t i CONTRACTOR: Company Name: Como r) Phone#: 7 /3 ?iti °/ 9 O c7 Address: 5-5`70 N 44) SST( 1 City: f E�S.� t i��fL Al-ir State: Zip: 3 3 3 ©4. Qualifier Name: .3-E e Q Y l4A AM State Certification or Registration #: S 1 Q 4.7 Certificate of Competency #: Contact Phone#: Qt(( - co ® 7.4 0 2 Email Address: _94te et 42 . Co-,e7 Q C art - ten -1 r nen DESIGNER: Architect/Engineer: Phone#: Phone#: ?13 • 20 I PC=,q u1-- Value of Work for this Permit: $ d �f on Sgnare/Linear Foo a of Work: to 5 Type of Work: UAddition OAlteration ONew air/Replace ' `r molition Description of Work: 1Zea.t.ov� isIINIMININFINOSE.. EX-rwa2-tr (? we, 4.... "02yvuALI —.B / T Color thru tile: ****** *** ***** ***s* *** *** **** *** **$**** ees **** * **** * * ** *** * *** * * * ** * ***** * * **a* d Submittal Fee $ Permit Fee $ /v O CCF $ CO /CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approve,; # a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this b day of MAX20 11; by BalkACO vius who is personally known to me or who has produced As identification and who did take an oath. NOTARY ' t LIC: APPROVED BY Contractor The foregoing instrument was acknowledged before me this 5114 day of wta 12.20 1_27, by '111 who is personally known to me or who has produced (� d J(r L a Ca r114 as identification and who did take NOTARY PUBLIC: , 2- i �-' /(19.00Plans Examiner Structural Review (Revised 3112/2012)(Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15109) Sign: Print: My Commission Expires: I to /J..1) Clerk DBPR - HANER, JERRY LYNN; Doing Business As: COTTON USA LP, Certified Gen... Page 1 of 1 11:25:44 AM 12/17/2012 Licensee Details Licensee Information Name: Main Address: County: License Mailing: LicenseLocation: County: License Information License Type: Rank: License Number: Status: Licensure Date: Expires: Special Qualifications Construction Business HANER, JERRY LYNN (Primary Name) COTTON USA LP (DBA Name) 6780 BRIAR RD AZLE Texas 76020 OUT OF STATE 6780 BRIAR RD AZLE TX 76020 OUT OF STATE Certified General Contractor Cert General CGC051967 Current,Active 11/28/1990 08/31/2014 Qualification Effective 12/13/2004 View Related License Information View License Complaint 1940 North Monroe Street. Tallahassee FL 32399 :: Email: Customer Contact Center :: Customer Contact Center: 850.487.1395 The State of Florida is an AA /EEO employer. Copyright 2007 -2020 Stat.. of Florida, privacy Statement Under Florida law, email addresses are public records. If you do not want your email address released in response to a public - records request, do not send electronic mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions, please contact 850.487.1395. *Pursuant to Section 455.275(1), Florida Statutes, effective October 1, 2012, licensees licensed under Chapter 455, F.S. must provide the Department with an email address if they have one. The emails provided may be used for official communication with the licensee. However email addresses are public record. If you do not wish to supply a personal address, please provide the Department with an email address which can be made available to the public. Please see our Chanter 455 page to determine if you are affected by this change. https:// www. myfloridalicense .com/LicenseDetail. asp ?SID= &id= CBAE6BAB31DA20EA... 12/17/2012 I L 0— r-, im I DEO 1 7 :E2 A OANo Miami Shores Village APPROVED ZONING DEPT BLDG DEPT SUBJECT TO COMPLIANCE WITH ALL FEDERAL STATE AND COUNTY RULES AND REGULATIONS ess oug_...:. Set. '" Mb Da 12 Ceti University proposed rem #cast tide SE TI N B Friable S sampled bey "Asbestos in document e f SAMPLING STRATEGY: GY: was conducted ac . Fnable d in the EPA 'Ti r Friabk Fnable Surfacing ate a les collected is based n a and the t p Thermal Sy - 1 named Winner from eb b Sampks are colleted from each or plastersse such gas in such s mama s Project 11 NEE I press, pies are collected in a randomly TSI not assumed to be ACM. opmeous axes of patched TSI. Where . cetne ees, elbows, ... or takes, . samples will be collected ctent to determine e whether the material is ACM or not d Aven $ "7700 Cu ss Ave 'tte, Sum .1119; k"t. ? 1) 24 < Mat : >: olentn, do not �eous ms M will pl in asbestos. The of to the discretion of Dov vironmental, Corp., % l subjected to Polarized ° c y .,.: , asp conjuncdon svi ou i ed in 763, of januaty 1987. Dove C . a : edited for asbestos fiber analysis through successful NISI" Natio Laboratory Accreditation pro P s 40 C Part 763. 87, Volume 52, and. Number 210. SECTION 1i— PROJECT SCOPE: The above-referenced p ,- : ty is a multi st l NE bd Avenue, Miami Shores, FL 33161. The sinvey was limited to wail of office 203 and no other areas were ° ... ted for suspea asb stns terial. The scope of this . project was to sample and identify ' potential y visible and accessible auras .f the :&da were inspected. D :. l ri process, materials hidden behind d a °di other enclosures may be covered which may it :: e further tes not included in this report plc specimens of suspect o Polarized Light t ' os conjunction ` ova 0 , Part 63, Subpart F dated , 1987. by Do o tal, Corp., . .. ; Fl who is fiber .... saaec p «' . d sue: e ado Vol= t Accr a d '; . • : ,.. d the,r .. 9 merits of section d} o Title 11 of the C _ 1 , arts C '763 dated _ April ,1987. The non- suspect 1) Concrete 2} Glass 3) Metal Uni NE 2na 'Avenue, i lt* SIMS, 1 33161 present are ed below: 77 u,, =.Avenue, . Suit 33487 (5611245.450:4 Those suspect asbestt ntanung .• terms that were present arre.l Interior wall materials consi,sted f a plash with a te' One of the y all . system was collected no asbes was °dete to mate SECTION III , e etll aibeS SE 0 Fed ESS 'VIEWS O AC are deed :gip the EPA-NES memo no assessment . of the mastic and oa was detected in e As EPP. e State Asbestos e Asb 2600 Blair °Stye Roy t .��rrta ... tae tope o a. ate tsdta ca. d the c essib c. apt ... P.. :. f wit and do not ma observe s die asst ptio that like 'aIs ux . s ess d:upon a Li p + ovation, operatio i planned renovation opex expected to be disturbed as submitted to the laboratory for asb have identified ufrd all of 'thc asbestos-con AirMD's opinions a noted its the re f °e -° ce ho for rem xxe z prior mspectian : a. coca susp ect asbe tom c t apx tend to d upon ace by others. Namc Josef Shapiro Flt: 33161 Date: 10 /20 tteg_ Suite .8'1':19 8 Raton, .L Page `4 of 5 7 (561 0,4041 #IN E tillaNY 00 R910 results and conclustoos as part of our asseaSnient are only representative of conditions at the dine of the AitigpViSit and do not represent conditions at thus . This report is intended for your use and yolit n :t - 4 1 ,... , t 0 ' Ii and nos:trent xhall. not be or relied .* *.. by other panic* . , Oar atubonzation of Aiwa Sincerely, Ste pbHby (*lifted Asbestos Inspector META Asbesun Inspector Ft Expiration thte: 3/15/13 AirMP, Inc. Honda Licensed Asbestos Consulting Finn ZA429 tAieatt Busy Efavasity 1Nrflp imer:Shootto Eufjci3Sitel. 13:300 NE Zul Aveit*,Wviii-Otorkt3,$.161 A ,FL3 (56112454 Owe 10124 Project Name/Num Physical as:sesmext assess of suspect CQXItaUUrIgbU4dmg nateiaIs Project Address:4001S° 5t Y4- Wkirt, 4# sessment areas: 0,s, Potential ACM: Potential ACM: Potential ACM: Potential ACM; Potential ACM: Potential ACM: Potential ACM: Potential ACM: Date: le Inspector Na LS 4p. Friable:} Area:14 Condition: 6Potential disturbance: IA Friable: P.) Area:40 Condition:el Potential disturbance:LI Locatcn Friable Area: Condition:C-Potential disturbance:tA cat1on: Friable: Area: Condition: Potential disturbance: Location: Friable: Area: Condition: Potential disturbance: Location: Friable: Area: Condition: Potential disturbance: Location: Friable: Area: Condition: Potential disturbance: Location: Friable: Area: Condition: Potential disturbance: Legend: Y: Yes 6: Good H: High N: No F: Fair M. Moderate B: Bad is Low 7700 Congress Avenue, Suite 1119, Raton, FL 33487(561) 245-45 Page 1 of 1 CORP. ;. FL 3 I AIR ft 7700 C 1 ASBESTOS T T R AVE 1119 7 FR H DESCRI T ASBESTOS OTHER FIBERS : NON P FIBERS FRI N e ESCRIPTION ASBESTOS TYPE: THER FIBERS NON FIBERS : 70% MI N 101 2 FL Y 02 ;. t TE . RESINS PFD b F N: . : 10/ 10% P A II DATE 03 10/ 101 RESINS FI aZZZXZWZIPZIZZZZSZ cyst Dees ` nt Name: Add :.; DOVE ENVIRONMENTAL DRAT° MO Miramar Parkwayt wit* 0 Warner Fl 33035 *' 9-7429) Dottie Web gip. fit® :Add Sompi Sampler Received a Condition of so nip Sampia loget maple login date: United States D rtiu nt of Comm 'bona! institute of Standards and Tee nolo y RI Certificate of Accreditation to ISO 17025:2005 `,;1 L.,\,F LAB {:OL)L JO" 053 -U Dove Environmental Corporation orations i`c Ailny. E I: 1!i3�t.tt`1 �.�i.'1 CLNurci2f'3, LW ASBESTOS U1 3LR AN ‘1_,\ S� t= .1� ��' , i, t ;- ,� CI' -c -; + "� .'f; {Ti 3 ?, - 4 ,3tli_. r' %t._ A -- tr Cttd.: ��. r�;tfri,�i 11ti6r-i etGq'r ?. .- FF li;r ,a' (, °i.Y k{,-: iI;U t;t_.r;,'. v' s. ri L� iJ. f:- �_it'�'i =.J rJr "i rai », •, its C::.yr ;74 i ,oil .' 1,- aM,,.,or. --,--, CcNil!`JC f:':1 1 N C 0 R P C) R A T rtificate# 7MEC515120<ilt This ;s 10 Stephen ilahessy 77u9 t_"or4'r� ja,, ; on (.07.1i/2)! ?, it Ii:,:_'a I.ai ;r;. t tpl;r for(;.)ht'd;fJS {.ICcred LdtioT7 (tJ1 {ni! "4�C't�ij +1Y7 A U iER,%. Asbestos E t I spectr Refrcr;her " kttr c ri. 44.1,4'0i't'.i t; the [J. tr M [2 - fl;+,! 5.' ,01?pr1djhtj:;rrr {Fri'sri5,ur 1 r:Nstr : ;;r, fit ior QP 0.5 1t'ith a sctn'c` of 7rl'; ,: or !Petit'$ 77C4 Cc,r ?.±)se Ave. c;,,� 1 at3 Fcat ^-r), FL :4C Ar.Me,3(4t, Eacpsre,4 Mr TA P.O. B x 786 - r, S E:6O44 STATE 0 ORIDA OP BUS 0850) ; -1 ERE STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 COTTON USA LP 14345 NORTHWEST FREEWAY HOUSTON TX 77040 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more aboutthe Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We nstantly strive to sery e you better so that you can serve your customers. ink you for doing business in Florida, and congratulations on your new license! DETACH HERE (850) 487 -1395 c:ri 7,4 ix,irciER 4;ir' tOtriirat •• ; t E.1,3 • ' • ef AUG tit2 tI •F a a 3V .20 V • r "a • • ••-. • - • ,.1.1var • ..- •i-r'. i * ...'7 14' • '• ' s' ' • *-',...4":'...., ..b• Ala,A;c44•1' ' . - .. •• 3. • . • • '.... . • . 1/0 . !...2:...1,--i4,4-.. .4.40..:4 .,t • . :7,-7 .;.; . • ' .in„ ' • •-..r , qi,„,i6. --,! . xt.-, ..,F.A. ./.:,.., • r,L.' ' ''" ..- I: -/- .• % '••••■1 ,-,;-, • " 1.".-7:120 1.1474'4. • ,' s „, ,,..' • • .,.,,...'*-40.4 fr...,r4trkg..., . • • . N. ...?,..... ... 444) wE .izx js...,i-se4 •. . . ... . . • • • • • • : 7. 410.4 • 444. • • • • ' • '1110, *3744 'V"" A R©J CERTIFICATE OF LIABILITY INSURANCE I 1?J17/201� 2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policypes) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In Lieu of such endorsement(s). PRODUCER Bowen, Midette & Britt Insurance Agency, LLC 1111 North Loop West, #400 Houston TX 77008 NCOANTACT Linda Tucker PHONE Fax . Ext1:713- 880 -7100 FA . Nok713- 880 -7166 ADDREss:ltudcer@bmbinc.com !NSURER(S)AFFORDING COVERAGE NAIC # INSURER A :Travelers Property Casualty Co of A INSURER LI :First Mercury Insurance Company 25674 10657 26883 31895 INSURED COTTONCOMM Cotton Commerdal USA, Inc. 5443 Katy Hodcley Cutoff Rd Katy TX 77493 insu Rc:Chartis Specialty Insurance Company INSURER D:American Interstate Ins Co INSURER E : 6/1/2012 INSURER F : EACH OCCURRENCE COVERAGES CERTIFICATE NUMBER: 302024192 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT Y0 EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. OMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POUCY PERIOD TO WHICH THIS ALL THE TERMS, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. TYPE OF INSURANCE ADDL MI SR WM POUCY NUMBER YYrn O DITYYY) (MuDy EXP Y) LIMITS B GENERAL X T AMMY COMMERCIAL GENERAL LIABILITY ILCGL000001193101 6/1/2012 3/1/2013 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $300, , MED EXP (Arty are fin) 1 $5,000 CLAIMS -MADE I X OCCUR PERSONAL & ADV INJURY i $1,000,000 GENERAL AGGREGATE 02,000,000 PRODUCTS - COMPPDPAGG 02,000,000 GEM. AGGREGATE LIMITAPPLIESPER: —1 PouCYn nwc LCOMBIAD $ A AUTOMOELE X X LABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON-OWNED AUTOS BA9A93451512 3 /1/2012 3/1/2013 SINGLE LIMY (Ea =Merit) $1,000,000 $ BODILY INJURY (Per person) I BODILY INJURY (Per ac t) $ PROPERTY (P accTdent)D $ C X UMBRELLA UAB EXCESSLIAB X OCCUR CLAIMS -MADE 8E011030786 6/1/2012 5/1/2013 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 $ DED I X 1 RETENTION $10,000 D WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE Y N / A AVWCTX2117872012 6/1/2012 3/1/2013 X I Tq y ATU- I EAR EL EACH ACCIDENT 01,000,000 CFFlCERK EMBER EXCLUDED? (Mandatory InNH) DESCRIPTION OF OPERATIONS below EL DISEASE- EA EMPLOYEE $1,000,000 EL DISEASE - POUCY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, IT more space Is regrdred) Additional Insured is afforded as per the attached endorsement Primary and Non - Contributory is afforded as per the attached endorsement Waiver of Subrogation is afforded as per the attached endorsement CERTIFICATE HOLDER CANCELLATION I Miami Shores Village 10050 NE 2nd Ave. Miami Shores FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010105) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYER LIABILITY INSURANCE POLICY WC000313 (444) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not en- force our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. 1. Q Specific Waiver Name of person or organization Schedule a Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: 3. Premium: 4. Minimum Premium: Maximum Premium: The premium charge for this endorsement shall be included in the premium developed on payroll in conjunction with work performed for the above person(s) or organization(s) arising out of the operations descnbed. This endorsement changes the policy to which It is attached effective on the inception date of the policy unless a different date is indicated below. (The following attaching" clause need be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective on 06/01/12 (Date) Policy No. AVWCTX2117872012 issued to Cotton Commercial USA, Inc. Policy Effective 06101/12 to (Date) Premium $ WC 00 0313 (4.84) 01983 National Coundi on Compensation insurance at 12:01 A.M. standard time, forms a part of Endorsement No. of the AMERICAN INTERSTATE INSURANCE COMPANY - 24759 (Name of Insurance Carrier end NCCI Carrier Code) 06/01/13 (Date) Cotton Commercial USA, Inc. BA9A93451512 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies Insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is exduded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and Is not covered. A. BROAD FORM NAMED INSURED B. BLANKET ADDITIONAL INSURED C. EMPLOYEE HIRED AUTO D. EMPLOYEES AS INSURED E. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS F. HIRED AUTO — LIMITED WORLDWIDE COVERAGE — INDEMNITY BASIS G. WAVER OF DEDUCTIBLE — GLASS PROVISIONS A. BROAD FORM NAMED INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — LIABILITY COV- ERAGE: Any organization you newly acquire or form dur- ing the policy period over which you maintain 50% or more ownership interest and that is not separately insured for Business Auto Coverage. Coverage under this provision is afforded only un- til the 180th day after you acquire or form the or- ganization or the end of the policy period, which- ever Is earlier. B. BLANKET ADDITIONAL INSURED The following is added to Paragraph c. In A.1,, Who Is An Insured, of SECTION 11 --- LIABILITY COVERAGE Any person or organization who is required under a written contract or agreement between you and that person or organization, that Is signed and H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE — INCREASED LIMIT 1. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT J. PERSONAL EFFECTS K. AIRBAGS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS M. BLANKET WAIVER OF SUBROGATION N. UNINTENTIONAL ERRORS OR OMISSIONS executed by you before the "bodily Injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an 'insured" for Liability Cover- age, but only for damages to which this insurance applies and only to the extent that person or or- ganization qualifies as an "Insured" under the Who Is An insured provision contained In Section 11, C. EMPLOYEE HIRED AUTO 1. The following is added to Paragraph A.1., Who Is An Insured, of SECTION 11 — LI- ABILITY COVERAGE: An °employee° of yours is an °insured° while operating an "auto° hired or rented under a contract or agreement in that °employee's° name, with your permission, while performing duties related to the conduct of your busi- ness. CA T3 53 06 09 © 2009 The Travelers Companies, Inc. Includes the copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 4 COMMERCIAL AUTO 2. The following replaces Paragraph b. in B.5., Other Insurance, of SECTION ry — BUSI- NESS AUTO CONDITIONS: b. For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "autos" you own: (1) Any covered °auto° you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented by your "employee" under a contract in that individual "employee's" name, with your permission, while perform- ing duties related to the conduct of your business. However, any "auto" that Is leased, hired, rented or borrowed with a driver is not a covered °auto ". D. EMPLOYEES AS INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION 11 — LIABILITY COV- ERAGE: Any "employee" of yours is an Insured" while us- ing a covered "auto" you don't own, hire or borrow in your business or your personal affairs. E. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS 1. The following replaces Paragraph A.2.a.(2), of SECTION II — LIABIUTY COVERAGE: (2) Up to $3,000 for cost of bail bonds (in- cluding bonds for related traffic law viola- tions) required because of an °accident° we cover. We do not have to furnish these bonds. 2. The following replaces Paragraph A.2.a.(4), of SECTION 11— LIABIUTY COVERAGE: (4) All reasonable expenses incurred by the "Insured' at our request, including actual loss of earnings up to $500 a day be- cause of time off from work. F. HIRED AUTO — LIMITED WORLDWIDE COV- ERAGE — INDEMNITY BASIS The following replaces Subparagraph e. In Para- graph B.7., Policy Term, Coverage Territory, of SECTION IV — BUSINESS AUTO CONDITIONS: e. Anywhere in the world, except any country or Jurisdiction while any trade sanction, em- bargo, or similar regulation imposed by the United States of America applies to and pro- hibits the transaction of business with or within such country or jurisdiction, for Liability Coverage for any covered "auto" that you lease, hire, rent or borrow without a driver for a period of 30 days or Tess and that is not an "auto" you lease, hire, rent or borrow from any of your "employees", partners (if you are a partnership), members (if you are a limited liability company) or members of their house- holds. (1) With respect to any claim made or "suit' brought outside the United States of America, the territories and possessions of the United States of America, Puerto Rico and Canada: (a) You must arrange to defend the "Insured" against, and investigate or settle any such claim or "suit" and keep us advised of all pro - ceedings and actions. (b) Neither you nor any other in- volved °insured° will make any settlement without our consent. (c) We may, at our discretion, par - tidpate in defending the "insured" against, or in the settlement of, any claim or "suit". (d) We will reimburse the Insured': (I) For sums that the Insured" legally must pay as damages because of °bodily injury" or "property damage° to which this insurance applies, that the "insured* pays with our consent, but only up to the limit described In Paragraph C., Limit Of Insurance, of SECTION 11 — LIABILITY COVERAGE; (11) For the reasonable expenses incurred with our consent for your investigation of such claims and your defense of the "insured" against any such "suit", but only up to and included within the limit de- scribed in Paragraph C9 Limit Of Insurance, of SECTION II — LIABILITY COVERAGE, Page 2 of 4 0 2009 The Travelers Companies, Inc. CA T3 53 06 09 Includes the copyrighted material of Insurance Services Office, Inc. with its permission. and not in addition to such limit. Our duty to make such payments ends when we have used up the applicable limit of insurance in payments for damages, settlements or defense expenses. (2) This insurance Is excess over any valid and collectible other insurance available to the "insured" whether primary, excess contingent or on any other basis. This insurance is not a substitute for re- quired or compulsory insurance in any country outside the United States, its ter- ritories and possessions, Puerto Rico and Canada. (3) You agree to maintain all required or compulsory insurance in any such coun- try up to the minimum limits required by local law. Your failure to comply with compulsory insurance requirements will not invalidate the coverage afforded by this policy, but we will only be liable to the same extent we would have been liable had you complied with the compulsory in- surance requirements. (4) It is understood that we are not an admit- ted or authorized insurer outside the United States of America, its territories and possessions, Puerto Rico and Can- ada. We assume no responsibility for the fumishing of certificates of insurance, or for compliance in any way with the laws of other countries relating to insurance. G. WAIVER OF DEDUCTIBLE — GLASS The following is added to Paragraph D., Deducti- ble, of SECTION I11 — PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage If the glass is repaired rather than replaced. H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE — INCREASED LIMIT The following replaces the last sentence of Para- graph A.4.b., Loss Of Use Expenses, of SEC- TION Ili — PHYSICAL DAMAGE COVERAGE: However, the most we will pay for any expenses for loss of use is $65 per day, to a maximum of $750 for any one "accident". CA T3 53 06 09 COMMERCIAL AUTO 1. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT The following replaces the first sentence in Para- graph A.4.a., Transportation Expenses, of SEC- TION 11I — PHYSICAL DAMAGE COVERAGE: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto" of the private passenger type. J. PERSONAL EFFECTS The following is added to Paragraph A.4., Cover- age Extensions, of SECTION 111 — PHYSICAL DAMAGE COVERAGE: Personal Effects We will pay up to $400 for loss" to wearing ap- parel and other personal effects which are: (1) Owned by an "Insured"; and (2) In or on your covered "auto". This coverage applies only in the event of a total theft of your covered "auto". No deductibles apply to this Personal Effects coverage. K. AIRBAGS The following is added to Paragraph B.3., Exclu- sions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Exclusion 3.a. does not apply to loss" to one or more airbags in a covered °auto° you own that in- flate due to a cause other than a cause of "loss" set forth in Paragraphs A.1.b. and A -1.c., but only: a. If that °auto° is a covered 'auto" for Compre- hensive Coverage under this policy b. The airbags are not covered under any war- ranty; and c. The airbags were not intentionally inflated. We will pay up to a maximum of $1,000 for any one loss". L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS The following is added to Paragraph A.2.a., of SECTION IV — BUSINESS AUTO CONDITIONS: Your duty to give us or our authorized representa- tive prompt notice of the °accident° or loss" ap- plies only when the "accident" or loss" is known to: (a) You (if you are an individual); ® 2009 The Travelers Companies, Inc. Page 3 of 4 Includes the copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL AUTO (b) A partner (d you are a partnership); (c) A member (if you are a limited liability com- pany); (d) An executive officer, director or insurance manager (if you are a corporation or other or- ganization); or (e) Any °employee° authorized by you to give no- tice of the "accident" or °loss °. M. BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.5,, Transfer Of Rights Of Recovery Against Oilers To Us, of SECTION IV — BUSINESS AUTO CONDI- TIONS: 5. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the ex- tent required of you by a written contract signed and executed prior to any °accident° or "loss", provided that the °ac ddent° or loss° arises out of operations contemplated by such contract. The waiver applies only to the person or organization designated in such contract. N. UNINTENTIONAL ERRORS OR OMISSIONS The following is added to Paragraph B.2., Con- cealment, Misrepresentation, Or Fraud, of SECTION IV — BUSINESS AUTO CONDITIONS: The unintentional omission of, or unintentional error in, any information given by you shall not prejudice your rights under this Insurance. How- ever this provision does not affect our right to col- lect additional premium or exercise our right of cancellation or non - renewal. Page 4 of 4 O 2009 The Travelers Companies, Inc. CA T3 53 06 09 Includes the copyrighted material of insurance Services Office, Inc. with its permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON - CONTRIBUTING INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance, and all subparts thereof, as contained in the policy 15 deleted in its entirety and replaced with the following condition: 4. Other Insurance If all of the other insurance permits contribution by equal shares, we will follow this method unless the insured is required by written contract signed by both parties, to provide insurance that is primary and noncontributory, and the 'insured contract' is executed prior to any loss. Where required by a written contract signed by both parties, this insurance will be primary & non-contributing only when and to the extent as required by that contract However, under the contributory approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. This endorsement forms a part of the Policy to which attached, effective on the inception date of the Policy unless otherwise stated herein. (The following information is required only when this endorsement is issued subsequent to preparation of the Policy.) Endorsement effective 06/01/2012 Named Insured Cotton Commercial USA, Inc. FMIC- GL- 1002(0512010) Policy Na- ILCGL000001193101 Endorsement No. Countersigned by POLICY NUMBER: ILCGL000001193101 COMMERCIAL GENERAL LIABILITY CG 24 0410 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: As required by written contract signed by both parties prior to Toss (if no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV — COMMER- CIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or 'your work" done under a contract with that person or organization and included in the "products- completed operations hazard'. This waiver applies only to the person or organization shown in the Schedule above. C0 24 04110 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 ❑ POLICY NUMBER: ILCGL000001193101 COMMERCIAL GENERAL LIABILITY CG 2010 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations As required by written contract signed by both parties prior to Toss . Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for °bodily injury", °property damage" or °personal and advertising injury° caused, in whole or in part, by 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the locations) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply. This insurance does not apply to °bodily injury° or "property damage° occurring after 1. All work, including materials, parts or equip- ment fumished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of 'your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 2010 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 0 POLICY NUMBER: ILCGL000001193101 COMMERCIAL GENERAL LIABILITY CG 20370704 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations As required by written contract signed by both parties prior to loss / commercial work only Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property dam- age" caused, in whole or in part, by "your work" at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products- completed operations hazard ". CG 20 37 07 04 © ISO Properties, Inc., 2004 Pagel of 1 0 • THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT - 30 DAY NOTICE OF CANCELLATION TO DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS COVERAGE PART It is agreed, the scheduled designated persons or organizations noted below will be given thirty (30) days notice of cancellation, except as respects non - payment of premium, for which ten (10) days notice will apply. SCHEDULED PERSONS OR ORGANIZATIONS: As required by written contract ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. This endorsement forms a part of the Policy to which attached, effective on the inception date of the Policy unless otherwise stated herein. (The following information is required only when this endorsement is issued subsequent to preparation of the Policy.) Endorsement effective 06/01/2012 Policy No. ILCGL000001193101 Endorseme N Named Insured Cotton Commercial USA, Inc. Countersigned by FMIC -GL -2012 (07/2011)