ALLIGATOR CREEK CHANNEL F DRAINAGE IMRPOVEMENTS - 03-0028-EN - CERTIFICATE OF LIABILITY INSURANCE (2)® DATE (MM/DD CERTIFICATE OF LIABILITY INSURANCE p
ID B
KEY
ST Fl 1 12/04
Fessler Agency-Clearwater
3165 North McMullen Booth Rd.
Clearwater FL 33761-2020
Phones727-726-3377 Faxs727-725-4698
INSURED
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC #
INSURER A: FCC.'I Insurance Company 10178
Keystone Excavators, Inc.
371 Scarlet Blvd.
Oldsmar FL 34677
COVERAGES
INSURER B:
INSURER C:
INSURER D: j
INSURER E:
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
NSR
TYPE OF INSURANCE j
POLICY NUMBER POLICY EFFECTIVE
DATE (MM/DD/YYYY) I POLICY EXPIRATION
DATE (MM/DDIYYYY)
LIMITS
GENERAL LIABILITY EACH OCCURRENCE j $ 1000000
A X COMMERCIAL GENERAL LIABILITY GL0009548 12/01/09 12/01/10 PREMISES (Eaoccurence) $ 100000
h
CLAIMS MADE ® OCCUR MED EXP (Any one person) s 5000
PERSONAL & ADV INJURY $1000000
X Per Proj Agg GENERAL AGGREGATE $ 2000000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s 2 0 0 0 0 0 0
POLICY 'X? JECOT n LOC
AUT OMOBILE LIABILITY j
COMBINED SINGLE LIMIT I
A
X
ANY AUTO
CA0014852
12/01/09
12/01/10
(Ea accident) S1000000
i
ALL OWNED AUTOS
BODILY INJURY
SCHEDULED AUTOS
(Per person) S
HIRED AUTOS BODILY INJURY
NON-OWNED AUTOS (Per accident) ( $
PROPERTY DAMAGE
i
(Per accident) $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC S
H AUTO ONLY: AGG $
EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ 10 0 0 0 0 0
A X OCCUR CLAIMS MADE UMB00009858 12/01/09 12/01/10 ! AGGREGATE $ 1000000
$
DEDUCTIBLE $
X RETENTION $10000 S
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY - -
TORY LIMITS ER ?
A Y/ N
ANY PROPRIETOR/PARTNER/EXECUTIVq-7 6 0 8 5 5 12/01/09 12/01/10 I E.L. EACH ACCIDENT $1000000
OFFICER/MEMBER EXCLUDED? u
(Mandatory in NH)
E.L. DISEASE - EA EMPLOYEE
$1000000
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$1000000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Projects Alligator Creek Channel F
City of Clearwater is listed as additional insured
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITYCL 5 DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
City of Clearwater
D1v1S10n REPRESENTATIVES. Construction u Myrtle Ave, Ste 220 AUT IZEDR PR NTATI
100
Clearwater FL 33758
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