CERTIFICATE OF INSURANCE (249)
ACORDm CERTIFICATE OF LIABILITY INSURANCE OP ID S~ DATE (MMIDDIYYYY)
KEYST-1 11/30/04
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Fessler Agency-Clearwater HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
3165 North McMullen Booth Rd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
Clearwater FL 33761-2020
Phone: 727-726-3377 Fax:727-725-4698 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Valley Forge Insurance 01839
INSURER B: Continental Casualty. Company
Keystone Excavators, Inc. INSURER C: Transportation Insurance Co. .. ..
Ke1stoneBay Area Corporation ..
37 Scarlet Blvd. INSURER 0: St. Paul Travelers Insurance \ 40282
Oldsmar FL 34677
INSURER E: .
COVERAGES
(1
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~~~ ~~~~ ~o.~~ll!'J:f_E.P.:rJVE P9~Lc:Y{~XPIRA T~N LIMITS
TYPE OF INSURANCE POLICY NUMBER DATE MM/DDNYI DATE MM/DDIYY
GENERAL LIABILITY EACH OCCURRENCE $ 1000000
- ~~~~:s~s (E~~~~~~nce)
A X COMMERCIAL GENERAL LIABILITY C1063782062 12/01/04 12/01/05 $ 50000
.1 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.COM~OPAGG $ 2000000
I IXl PRO. nLOC
POLICY X JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $ 1000000
B X ANY AUTO C2024661613 12/01/04 12/01/05 (Ea accident)
-
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
-
X HIRED AUTOS BODILY INJURY
- $
X NON.OWNED AUTOS (Per accident)
~ --,
f--- , PROPERTY DAMAGE $
. (Per accident)
GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 1000000
C 8 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 L1Mtn; 1 IU~~-
A EMPLOYERS' LIABILITY WC1063782093 12/01/04 12/01/05 $ 1000000
ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? EL. DISEASE - EA EMPLOYEE $ 1000000
-' ._, '"if yes;--ae;:...... iut;; UIIUIC'I -.----.--,,--- --r-'--- -., .. --- ._----._~._._~-- ----.- ---.,- i--...---. - --'- --- -' -~-----~-,~ --- ~.c~_="~~_~~,~~. ~~~~..--~...--. -.--.- co"~
SPECIAL PROVISIONS 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 / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Certificate holder is named as additional insured with respect to job at
J Mandalay Ave. , /Papaya Street/San Marco Reconstruction (99-0098-EN)
CERTIFICATE HOLDER CANCELLATION
CYTCLEA 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
City of Clearwater
100 So. Myrtle Ave.
Clearwater FL 33756
@ ACORD CORPORATION 1988
ACORD 25 (2001/08)
+2