Loading...
CERTIFICATE OF LIABILITY INSURANCEKEYST -1 OP ID: SB ACORO' 1.........-- CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 05/19/14 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 Fessler Agency - Clearwater 727- 726 -3377 3165 N McMullen Booth Road G -2 727 - 725 -4698 Clearwater, FL 33761 -2020 Case J. Fessler, AAI, CIC CONTACT PHONE FAX (A/C. No. Ext): (A/C, No): E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : National Trust 20141 INSURED Keystone Excavators, Inc. 371 Scarlet Blvd. Oldsmar, FL 34677 INSURER B: FCCI Commercial Insurance Co. 33472 INSURER C: FCCI Insurance Company 10178 INSURER D : Allied World Assurance Co. 25623 INSURER E : Allied World Assurance Co. $ 100 000 INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. INSR LTR TYPE OF INSURANCE .. INSR SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY GL000954835 ( )' 12/01/13 12/01/14 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100 000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES 7 POLICY n PRO - IFST PER: LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS " CA00148525. _. 12/01/13 12/01/14 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE UMB00098585 12/01/13 12/01/14 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 DED X RETENTION $ 10000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/ N N / A 60855 12/01/13 12/01/14 X TWY MT- S 06R - E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 D E Equipment Floater POLLUTION 6603842B003 BINDER 3066 12/01/13 05/10/14 12/01/14 05/10/15 LIMITS 250,000 LIMITS 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Project: Lake Chautauqua Trail CERTIFICATE HOLDER CANCELLATION CITYCLE City of Clearwater Parks, Planning Mgr. 100 South Myrtle Ave., #220 100 Leroy Myrtle '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 0( 1 ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD KEYST -1 OP ID: SB A�... °RL CERTIFICATE OF LIABILITY INSURANCE DATE 05 /19D/YYYY) 05/19/14 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 727 - 726 -3377 Fessler Agency - Clearwater 727-725-4698 3165 N McMullen Booth Road G -2 Clearwater, FL 33761 -2020 Case J. Fessler, AAI, CIC CONTACT NAME: PHONE FAX (A/C. No, Ext): (A/C, No): E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : National Trust 20141 INSURED Keystone Excavators, Inc. 371 Scarlet Blvd. Oldsmar, FL 34677 INSURER B : FCCI Commercial Insurance Co. 33472 INSURER c :FCCI Insurance Company 10178 INSURER D : Allied World Assurance Co. 25623 INSURER E : Allied World Assurance Co. $ 100,000 INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. INSR LTR TYPE OF INSURANCE ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X X GL000954835 + ^� / 12[01/13 12/01/14 EACH OCCURRENCE $ 1,000,00, DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,001 PERSONAL & ADV INJURY $ 1,000,001 GENERAL AGGREGATE $ 2,000,001 GEN'L AGGREGATE LIMIT APPLIES PER: 7 POLICY n PE O n LOC PRODUCTS - COMP /OP AGG $ 2,000,001 $ A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS X X .. .. CA00148525 - . - ' 42/01113 12/01/14 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,001 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE UMB00098585 12/01/13 12/01/14 EACH OCCURRENCE $ 4,000,001 AGGREGATE $ 4,000,001 DED X RETENTION $ 10000 $ C WORKERS COMPENSATION AND EMPLOYERS' UABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A X 60855 12/01/13 12/01/14 X I TORY LIMITS I ER E.L. EACH ACCIDENT $ 1,000,001 E.L. DISEASE - EA EMPLOYEE $ 1,000,001 E.L. DISEASE - POLICY LIMIT $ 1,000,001 D E Equipment Floater POLLUTION 6603842B003 BINDER 3066 12/01/13 05/10/14 12/01/14 05/10/15 LIMITS 250,001 LIMITS 1,000,001 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule if more space is required) BID ONLY / Certificate holder is included as additional insured per form CG2033 & CGL021 on the GL; Auto per form CAU001. *Limited Professional (Contractors E &O) per form CGL004. Policies are primary & non - contributory Waiver of Subrogation is included on the GL per form CGL004; Auto per form CAU014 & WC per form WC000313 *30 days notice of cancellation, next page CERTIFICATE HOLDER CANCELLATION CITYCL2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS. Attn: City Clerk 100 Myrtle Ave. AUTHORIZED REPRESENTATIVE 5820 Clearwater, r Clearwater, FL 33758 0( 1 ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NOTEPAD: HOLDER CODE CITYCL2 INSURED'S NAME Keystone Excavators, Inc. KEYST -1 OP ID: SB 10 days for nonpayment Separation of Insured per form CG0001