CERTIFICATE OF LIABILITY INSURANCE (821) ' DATE(M
Wfa1fYYYY)AC"R" CERTIFICATE OF LIABILITY INSURANC 121912018
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS LIACtN T I ' IF' ATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR INEGATIVELY AIMEND,EXTEND OR ALTER THE COVE'RAGIr, FORD BY THE POLICIES
BEJLO''!Y�Md. THIS CERTIFICATE OF INSURANCE DOES NOT CON'S'T'IT'UTE A C'ONTRAC'T BETWEEN THE ISSUIN� ER(S),AUTHORI'ZE'D
REPRE'SE'NTATIVE OR PRODUCER,AND THE CERTIFICATE(HOLDER.
IMPORTANT. If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SU'BROGATIOtlN 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 Mutual Insurance Inc.nce . CONTACT WillOrn Wanless�ext.,,,,2213
19001st Ave North (727)$96 0006 c (727,
PHONIC _ .-821 7483
(Alias o,E,uI. _..
PO(Box 12350 ADDRESS--.. WMwanless mutualinsurancelnc com
_ ---- 1_ - ----------._
St Petersburg FL 33713- INSURER(T,IAFFDRDING._COVERAGwI
_., - Euc,t
Auto Owners Insurance Co
_- ........ .._ - -----.. --- ...
INSURED INSURER.,q,,Southern Owners Inns Co 101go
_...
Tlropilgas Of Florida Inc&Billy J Bowling INSURER c,„
11163 54 Ave S IN (pREB-(a
St Petersburg FL 33705-5005 ITt.$IIItER.E,
COVERAGES CERTIFICATE NUMBER; R'E'VISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW NAME BEEN ISSUED TO THE INSURED INAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOT'WI"THS'T"ANDING ANY REQUIREMENT,TERM(OR CONDITION OF ANY CONTRACT OR C"R"IHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE(ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES IDESCRIBED HEREIN IS SUBJECT TO ALL THE T RIMIS,
EXCLUSIONS AND CONDITION'S OF SUCH P'OLICIE'S"LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMIS.
9N7�R.... .. TYPE OF INSURANCE X66—.�SiUOR.,,_ ........... P. _— .. ...�,.wqm _._._ �... OLICY ErF POLICY EXP LtlhGI'r5
LTR B GENERAL(LIABILITY 20595818 0110112017 1/0112018 EACH OCCURRENCE 11-1,-0----0---0---,--0----0--1-0
X...
DAMAGE TO RENTED $ 31D4D,R�I)kT
IAB11..3"I" PREMISES(Eanecarmnc�a
eo�aCLAI��MSMAOEEy XP,�OCCUR MEraEXIPfA cfukrq%gnry �._....._..... 10,000
X No Deductible PERSONAL&ACV(INJURY $ 1,000,606
......... .-
-- -- 11 Bg...._.
----- ... --------- GENERAL AGGREGATE $ gO000
G'F:rJ L AGGRE'.. ....
aaM +OEAGG. ,.$... 1,000,000
CvA"P"E LIMIT APPLIES PER r'PT,C.EY4UGT5: ----------------------------
IFCT
X POLICY PRAT- LOC $
A AUTOMOBILE LIABILITY 42519¢1000 1l01J2017 01101/2018 COMBINED LIMn 500,000
X . •--
ANY AUTO BODILY INJURY(Per person) $
_ ---------
ALL OWNED SCHEDULED .. _-
6demgi $
AUTOS AIU'T"OS'
BaaILY Ir�LII9R'Y(Per Ica,.. ..r......................,. . .m_. _...---._..
NON-OWNED PROPERTY DAMAGE
X HIRED AUTOS AUI OS �It �Wr NarnlR $
UMBRELLA IUAB AGCRQCCU RENCE, -_
EXCESS LIIAB .µ
.., ... .......... .. t,L,AIfAR•MOAIaL .... ,.... .. :.. .,.
N
A WORKERS COMPENSATION 20628445 02/04/2017 004J2018 WVC srATU- CDT"H-
ANa EMPLOYERS"LIABILITY YIN — ,. ...- . , .—.... ..AINYPROP+RIbTOR}PARTINERJEXEC 1"'IVE �)(
_L EACHACCiIJENT �_._.... 100,000
OFFICPRJMEMIBER EXCLUDED? � N I A I .... i
(Mandatory E,I,. DISEASE.. IE•,alh-7w>IPLOYEE S. '(010,(Mandatory In�Nr1II &I
III Ia u vuarr""b .. C.L DISICASE•POLICY LIr IT 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS r VEHICLES(Aadan:h ACORD 1101,Addil o nM IRemarks Schedule,If more space Is required)
30 Days notice of Cancellation except for 101 days notice for non-payment of premium,
CERTIFICATE HOLDER CANCELLATION Ai 00430,7
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Gas Sales THE EXPIRATION DATE THEREOF, NOTICE WALL IBE DELIVERED IN
Sales OFC/Tarn!,lo Watson ACCORDANCE WITH THE POLICY PROVISIONS.
711 Maple St
Clearwater FL 33755-3833 AUTHORIZED(REPRESENTATIVE
C}1988.2010 ACORD CORPORATION. All rights reserved.
ACORD 25(201010'5) The ACORD name and logo are registered marks of ACORD