CERTIFICATE OF LIABILITY INSURANCE (151)13769
ACRD CERTIFICATE OF LIABILITY INSURANCE
kilmo----.
DATE (MM /DDIYYYY)
6/7/2013
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 policy(Ies) 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
Commercial Lines - (813) 639 -3000
Wells Fargo Insurance Services USA, Inc.
2502 N. Rocky Point Drive, Suite 400
Tampa, FL 33607
CONTACT Certificate Dept
NAME: p
S POLICY EFF U
MMIDD/YYYY
6/1/2013
PHONE 813.639.3000 FAX
(A/C, No, Est): (NC, No):
813.639.7180
E-MAIL RES: dw•certrequest @wellsfargo.com
INSURER) AFFORDING COVERAGE
NAIC #
18988
INSURERA: Auto- Owners Insurance Co.
INSURED
Mid County, Inc
dba Barger Builders
2100 16th Street North
St. Petersburg, FL 33704
INSURER B :
X
INSURER C :
DAMAGE TO RENTED
PREMISES (Ea occurrence)
MED EXP (Any one person)
INSURER D :
INSURER E :
INSURER F :
• 61628
REVISION NUMBER: See below
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
TYPE OF INSURANCE
ANSR
SUBR
POLICY NUMBER
S POLICY EFF U
MMIDD/YYYY
6/1/2013
POLICY EXP L
MMIDDMfYY
6/1/2014
LIMITS
A
GENERAL LIABILITY
2065147713
EACH OCCURRENCE
$ 1,000,000
X
COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
PREMISES (Ea occurrence)
MED EXP (Any one person)
$ 50,000
$ 5,000
CLAIMS -MADE I X j OCCUR
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP /OP AGG
$ 1,000,000
POLICY
PRO-
JECT
LOC
$
AUTOMOBILE LIABILITY
--n _
-. ,
COMBINED SINGLE LIMIT
(Ea accident)
ANY AUTO
BODILY INJURY (Per person)
$
ALL OWNED
AUTOS
HIRED AUTOS
SCHEDULED
NON -OWNED
AUTOS
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
' '
EACH OCCURRENCE
$
AGGREGATE
$
DED
RETENTION $
$
WORKERS COMPENSATION
- r
�'•'
,
`.
WC STATU-
TORY LIMITS
OTH-
ER
$
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
Y / N
NIA
E.L EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
$
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule if more space Is required)
LICENSEE: JOHN W. BARGER JR. #CGC010697
CITY OF CLEARWATER
PO BOX 4748
CLEARWATER FL 33756
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
9(, ._
001448
ACORD 25 (2010/05)
The ACORD name and logo are registered marks of ACORD
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Commercial Lines - (813) 639 -3000
Wells Fargo Insurance Services USA, Inc.
2502 N. Rocky Point Drive, Suite 400
Tampa, FL 33607
CITY OF CLEARWATER
PO BOX 4748
CLEARWATER FL 33756
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001447
11111111111111111111110101111111101111111
'CY601 A07/000643!61 l02l0IOION'