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JEFFORDS ST OUTFALL - 10-0032-EN - CERTIFICATE OF LIABILITY INSURANCE
KEYST -1 OP ID: SI ,acoRCjm CERTIFICATE OF LIABILITY INSURANCE ► � —,-"'� DATE 10/09/209/20 15 5 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 3165 N McMullen Booth Road G -2 NAME: Case J. Fessler, AAI, CIC PHONE FAX A/c No Ext : 727 -726 -3377 (A/C, No): 727 - 725 -4698 Clearwater, FL 33761 -2020 Case J. Fessler, AAI, CIC E -MAIL cfessler fesslera enc com ADDRESS: g y• COMMERCIAL GENERAL LIABILITY INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:National Trust 20141 $ 1,000,000 INSURED Keystone Excavators, Inc. INSURER B: FCCI Insurance Company 10178 371 Scarlet Blvd. Oldsmar, FL 34677 INSURERC: Phoenix Insurance Company 25623 12/01/2015 DAMAGE TO RENTED PREMISES Ea occurrence INSURER D INSURER E : $ 5,000 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 DDL INSD UBR WVD POLICY NUMBER POLICY EFF MM /DD /YYYY POLICY EXP MM /DD /YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE lyll OCCUR X GL000954836 12/01/2014 12/01/2015 DAMAGE TO RENTED PREMISES Ea occurrence 1OO OOO $ , MED EXP (Any one person) $ 5,000 X Per Proj Agg PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY JjECT [::] LOC PRODUCTS - COMP /OPAGG $ 2,000,000 $ OTHER I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ A ANY AUTO CA00148526 12/01/2014 12/01/2015 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X X NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 B EXCESS LAB CLAIMS -MADE UMB00098586 12/01/2014 12/01/2015 DED X RETENTION $ 1 0000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETOR /PARTNER /EXECUTIVE � OFFICER /MEMBER EXCLUDED? (Mandatory in NH) N /A 60855 12/01/2014 12/01/2015 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 C LEASED /RENTED 66038428003 12/01/2014 12/01/2015 LIMITS 300,000 EQUIPMENT DED 2,500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Jeffords Outfall Project. City of Clearwater is included as a General Liability additional insured, pursuant to the terms and conditions of the policy. CERTIFICATE HOLDER CANCELLATION CITYCLE 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: Alice Eckman AUTHORIZED REPRESENTATIVE 100 South Myrtle Ave., Clearwater, FL 33756 C41,C_ 7_a� © 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD