CERTIFICATE OF INSURANCE (248)
ACORDm
CERTIFICATE OF LIABILITY INSURANCE
OPID S
KEYST-1 11 30
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
04
PRODUCER
Fessler Agency-Clearwater
3165 North McMullen Booth Rd.
Clearwater FL 33761-2020
Phone: 727-726-3377 Fax:727-725-4698
INSURED
INSURERS AFFORDING COVERAGE
KI':1YIil to.ne Excava tors, Inc.
Keystone Bay Area Corporation
371 Scarlet Blvd.
Oldsmar FL34677
INSURER A:
INSURER B:
INSURERC:
INSURER D:
INSURER E:
Valley Forge Insurance
NAIC#
01839
Continental Casualty Company
Transportation Insur,ance' Co.
St. Paul Travelers Insurance
40282
COVERAGES
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,
I~~~ ~~~~ POLICY NUMBER POLI%EFFECTI~E p<?~!Cr(~X~!.RA_~N LIMITS
TYPE OF INSURANCE DATE MM/DDIYY DATE MM/DDIYY
GENERAL LIABILITY EACH OCCURRENCE $ 1000000
- PRE'MISES (E~~~~~r~nce)
A X COMMERCIAL GENERAL LIABILITY C1063782062 12/01/04 12/01/05 $ 50000
I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 5000
X XCU COVERAGE PERSONAL & ADV INJURY $ 1000000
X CONTRACTURL LIAB GENERAL AGGREGATE $ 2000000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2000000
I !xl PRO- nLOC
POLICY X JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000
-
B X ANY AUTO C2024661613 12/01/04 12/01/05 (Ea accident)
c--
ALL OWNED AUTOS BODILY INJURY
f-- (Per person) $
SCHEDULED AUTOS
r--
X HIRED AUTOS BODILY INJURY
r-- (Per accident) $
~ NON-OWNED AUTOS
r-- .... PROPERTY DAMAGE $
. (Per accidenl)
GARAGE.LIABILtTY ' AUTO ONLY. EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 1000000
C ~ OCCUR D CLAIMS MADE C2054175059 12/01/04 12/01/05 AGGREGATE $ 1000000
$
Fx=l DEDUCTIBLE $
X RETENTION $10000 $
WORKERS COMPENSATION AND X I TORY LIMITS I IUJ~-
A EMPLOYERS' LIABILITY WC1063782093 12/01/04 12/01/05 . $ 1000000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.l. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? _.,---,~--- --. --~..---- ------- .uu ----~- - --- --5..b;--~-,-eA--EMPl.-0-V-EE sl.oOOOOQ -'--
-,_. _" ______.._'____n__ __._.______._ ---~- .-.--.---
~~~MtS~Wc5V~~16~s below E.L DISEASE - POLICY LIMIT $ 1000000
OTHER
D Leased &: Rented TO BE DETERMINED 12/01/04 12/01/05 $150000
$2500 ded
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
RE: South Beach Reclaimed Water Distribution System (99-0073-UT)
CERTIFICATE HOLDER
CANCELLATION
CITYCLE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ 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
Municipal Services Bldg.
100 South Myrtle Ave.,
Clearwater FL 33756-5520
@ACORD CORPORATION 1988
ACORD 25 (2001/08)