CERTIFICATE OF LIABILITY INSURANCE (116)��, �P IU: BMH
'4`„�'�° CERTIFICATE OF LIABILITY INSURANCE °ATE,M�'°°,"""",
D8/30/71
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIQN ONLY AND CONFEItS Np RIGHTS UPON THE CERTIFICAT� HOLDER. THIS
CERTIFICAT� DOES NOT AFFIRMATIVELY QR NEGA7IV�LY AMEND, EXT�Nb OR ALT�R THE COVERAG� AFFORDED 8Y THE POLICIES
BEI.OW. THIS CER7IFICATE OF INSURANCE DOES NQT CpNSTITUTE A CONTRACT BETWEEN THE ISSUINCy INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, ANn iFiE CERtIFICATE HOLDER.
IMPORTANT: If the certificate halder is an ADDITIONAI. INSURE�, the policy�ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditians of th� policy, c�rtain pvlicies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such andorsement s.
PRO�UCER 951-296-B8q0 CONTACT . �
COr�1Br5tU11@ SUfE�! E�.I11SU�817C0 � PHONE FAX
Temecula 851-296-68Q8.�A�c,_No,.�xry :.... .... ............ _._._.__.........:.. . . . . (q�c,No�:
40960 California Oaks Rd: #203
Murrieta, CA 92562
J. Tony Ruix
.._.. --- ..................-�-----�-��-----._.....---�---.._.._..._..._..-�----...----._..._._.....
INSURED The Bergman Companies
B�B Contractors, Inc.
Bergman Brothers Contractors
Inc.
a3dU �disan Ave
Chlno, CA 9177p
--- ----- - ----�
PROtiUCER __.. __ . . ... .._....._.
cu5ro�e� �a n;.RERGM-1. .. . . .. .. : . . .. ... . .. . . . . . ... . . _._...... ._._....
. ...... .INSURER(8)_AFFORDINCi C.._ . ERA6E ... ., . , .. . , .,,,...,.. , NAIC #_, ---..
OV
...... ........... �...... ... �.....�....... . �.�.........,.-�-------�- � -� -----
iNSUR�a a: National Fire Insurance 20478
INSU _ER B_' V8� B..- e �C1S .C..-- --._..._._._..__....---- __._...._._.. .-.-.--.-......... �Z� 32.-- -- .
R - �....._._.. �...Y_.Foi�g._.._...._.---°--
iNSUR�R c; American Cas Ca af 20427
_iwsu��R.,o.i..W�rtford_Casu�lty� ins _Co--- ----- -- _.._._-_.l.__.._ __.. 0022x9..__,___..
INSURERE Carolina Casual �f1S C.O
10510
COVERAGES CEi2TIFICATE NUMBER: REVISIpN NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LIST�D B�LQW MAVE BEEN ISSl1ED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIQD
INDICATED_ NQTWITM$TANpING ANY REQUIREMENT, TERM OR CONQITION OF ANY CONTRACT aR QTHER DOCUMENT WITH RESPECT TD WMICM THIS
CERTIFICATE MAY RE ISSIIED OR MAY I'EF27AIN, TH� INSURANCE AFFORDED BY TH� POI.ICI�S DESCRIBEp MEREIN IS SUBJECT TO Al.l THE TERMS,
EXCLUSIONS AN� CONDITIONS OF SUCH POLICIES. LIMITS SMOWN MAY HAVE BEEN R�DUCED BY PAIO CLAIMS.
INSR � AUDL SUBR POLICY 6FF POLICY 6XP LIMITS 1--.....--
LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MNUPBIYYYY
GENERAL LIAHILITY EACH OCCURRENCE $ �I �ODO�OO
A X CLAIMS-MADE X OCCUR .ME EXP.$Aneo�.rt'�s!!�I....�..�.$��.,.,...,.�� ,._..,..... S��O
�..... - -- . .
COMMERCIAL GENERAL LIABILITY C208$538603 08/31/11 08/31l12 '��
._...._..._._..,.
._.� u
E X E&O/Blanket Contr 1045117 08/09/11 06/09/12 pERSONAL & A�V INJURY $ �������0
X F��IIUt10f1/XCFaU � GENERALAGGREGATE $ ��OOO�OO
� GEN'L AGGREGAT� LIMIT APPLIES PER[f� PRODUCTS - GOMPlOP AGG $ �Z�OOO�OO
PpLICY X PR0 �� �oc Prpf Li�b.. $�� 1��00���
AUTOMOBII.E I.IABII.ITY GOMBINED SINGLE LIMIT $ '� �ODO�OO
(Ea acciden[)
� X nNV nuro U2093452205 08/31/11 08/37/12 BODILY INJURY (Per person) $ �
ALL oWNEO AUTOS BODILY INJURY (Per accidenT) $ �
SCHE�l1LED AUTOS PROPERTY DAMAGE �
X HIREA AUTp5 . � (Per eccldent) �
- i
X � NON-�WNED AUTOS $
$
UMBRELLA LIA9 X OCCUR � �+GH pCGURRENCE � 'I O�DOD�OD
E7(CESSLIAB CLAIMS�uL4DE AGGREGATE $ � �O�O�O�OO
C U2093290284 �8/31/11 �8/31/12
oEpUCTIBIE $
�.._`_._r... ---- -.._. _ ._�._�_.,—...— — --- ------- ....
— ---- �EIENIION � --._ _..__— �..-- —w..�..— .�..._.�_
��WORK�RS COMPEN5ATION � X WC STATU- OTH-
ANU EMPLOYERS' LIABILI7Y
D ANY PROPRIETpR/PARTNER/EXECUTIVE Y'-r 7-N- S7WE�72814 05/01111 05/01112 E.L. EACH ACCIDENT $ ��OQO�OO
OFFICERMIEMBER EXCLUDE�7 ��� N r a
(MandaMry in NH) I E.L. DISEASE - EA EMPLOYEE S 1,OD0,00
If yes, desaiba under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMI7 $ 'I �OOO�OO
q Installation float U2p9329o296 08/31/11 08/31/12 2500 Ded 26D,o
RntdlLsd 250� Ded 100,00
�HSCRIPTION OF Op�RA710NS ! LOCATIONS / VEHICLES (A@ach ACORD 1�1, AddRlonal ROmarks Schadule, If more �pace Is requlred]
Proof of insurance only
w�e���w�w�Y���w� e��� A�\�AC� � AT�A\�
c��a�wa
�c n/� SHOULD ANY OF THE A80VE DESCRIBED PbLICIES BE CANGELLED BEFaRE
,�' �� S' 7 THE EXPIRATION �ATE THEREpF, NOTICE WILL BE DELIVERED IN
ACCdRDANC� VIII7H THE POLICY PROVISIONS.
City of Clearwater Florida
Contractors Licensing Board S�P Q� 2Q��
PO BOX �%4S AUTHORIZEP REPRESENTATNE
Clearwater, FL 3375$-4748 � � , +
ACORD Z5 (2009/09)
�.a, � �e:�:�l � ' i� - `�
�,��j,ls�9��'�; �y;�� �,� p�� � 1988-2008 ACQRD CORPORATION. All rights reserved.
7he ACORD name and logo are registered marks of ACORp