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CERTIFICATE OF LIABILITY INSURANCE - RFQ 24-16 (6) KEYST-1 OP ID: BT DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 09/19/2016 THISCERTIFICATEISISSUEDASAMATTEROFINFORMATIONONLYANDCONFERSNORIGHTSUPONTHECERTIFICATEHOLDER.THIS CERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND,EXTENDORALTERTHECOVERAGEAFFORDEDBYTHEPOLICIES BELOW.THISCERTIFICATEOFINSURANCEDOESNOTCONSTITUTEACONTRACTBETWEENTHEISSUINGINSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT:IfthecertificateholderisanADDITIONALINSURED,thepolicy(ies)mustbeendorsed.IfSUBROGATIONISWAIVED,subjectto thetermsandconditionsofthepolicy,certainpoliciesmayrequireanendorsement.Astatementonthiscertificatedoesnotconferrightstothe certificate holder in lieu of such endorsement(s). CONTACT Case J. Fessler, AAI, CIC PRODUCER NAME: Fessler Agency-Clearwater FAX PHONE 727-726-3377727-725-4698 3165 N McMullen Booth Road G-2 (A/C, No): (A/C, No, Ext): E-MAIL Clearwater, FL 33761-2020 cfessler@fessleragency.com ADDRESS: Case J. Fessler, AAI, CIC INSURER(S) AFFORDING COVERAGENAIC # National Trust20141 INSURER A : Keystone Excavators, Inc. 10178 INSURED FCCI Insurance Company INSURER B : 371 Scarlet Blvd. Allied World Assurance Co. INSURER C : Oldsmar, FL 34677 40282 Travelers Insurance Company INSURER D : INSURER E : INSURER F : COVERAGESCERTIFICATE NUMBER:REVISION NUMBER: THISISTOCERTIFYTHATTHEPOLICIESOFINSURANCELISTEDBELOWHAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIOD INDICATED.NOTWITHSTANDINGANYREQUIREMENT,TERMORCONDITIONOFANYCONTRACTOROTHERDOCUMENTWITHRESPECTTOWHICHTHIS CERTIFICATEMAYBEISSUEDORMAYPERTAIN,THEINSURANCEAFFORDEDBYTHEPOLICIESDESCRIBEDHEREINISSUBJECTTOALLTHETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDLSUBR POLICY EFFPOLICY EXP INSR TYPE OF INSURANCELIMITS POLICY NUMBER (MM/DD/YYYY)(MM/DD/YYYY) LTR INSDWVD AX 1,000,000 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE$ DAMAGE TO RENTED X GL00095483712/01/201512/01/2016100,000 CLAIMS-MADEOCCUR$ PREMISES (Ea occurrence) 5,000 MED EXP (Any one person)$ X Per Proj Agg 1,000,000 PERSONAL & ADV INJURY$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ X PRO- 2,000,000 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY $ (Ea accident) AX CA0014852712/01/201512/01/2016 BODILY INJURY (Per person)$ ANY AUTO ALL OWNEDSCHEDULED BODILY INJURY (Per accident)$ AUTOSAUTOS NON-OWNED XX PROPERTY DAMAGE $ HIRED AUTOS (Per accident) AUTOS PIP10,000 $ X X 5,000,000 UMBRELLA LIAB EACH OCCURRENCE$ OCCUR B UMB0009858712/01/201512/01/20165,000,000 EXCESS LIAB CLAIMS-MADEAGGREGATE$ X 10000 $ DEDRETENTION$ PEROTH- WORKERS COMPENSATION X STATUTEER AND EMPLOYERS' LIABILITY Y / N B 6085512/01/201512/01/20161,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVEE.L. EACH ACCIDENT$ N N / A OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under 1,000,000 E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below C POLLUTION5152132211/02/201511/02/2016LIMITS2,000,000 D 6603842B00312/01/201512/01/2016LIMITS300,000 EQUIPMENT FLOATER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is included as additional insured on the GL & Auto Liability *Limited Professional(Contractors E&O)Policies are primary & non-contributory.Waiver of Subrogation is included on the GL; Auto Liability & Workers Compensation.Includes Separation of Insured *30 days notice of cancellation,10 days for nonpayment CERTIFICATE HOLDERCANCELLATION CITYCL9 SHOULDANYOFTHEABOVEDESCRIBEDPOLICIESBECANCELLEDBEFORE THEEXPIRATIONDATETHEREOF,NOTICEWILLBEDELIVEREDIN ACCORDANCE WITH THE POLICY PROVISIONS. City of Clearwater Engineering ContractSpecialist AUTHORIZED REPRESENTATIVE RFQ#24-16 Po Box 4748 Clearwater, FL 33758-4748 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01)The ACORD name and logo are registered marks of ACORD