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CERTIFICATE OF LIABILITY INSURANCE (4)KEYST -1 OP ID: SI A/ROr CERTIFICATE OF LIABILITY INSURANCE DATE,MM / ° °""") 11/22/2016 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 Clearwater, FL 33761 -2020 Case J. Fessler, AAI, CIC NAME: ACT Case J. Fessler, AAI, CIC PHONE 727.726 -3377 FAX 727- 725 -4698 (A/c, No, Bet): (A/C, No): E-MAIL ADDRESS: cfessler @fessleragency.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : National Trust 20141 INSURED Keystone Excavators, Inc. 371 Scarlet Blvd. Oldsmar, FL 34677 INSURER B : National Trust 20141 INSURER C: Allied World Assurance Co. 12/01/2017 INSURER D: Travelers Insurance Company 40282 INSURER E : INSURER F : X I OCCUR 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. NOTIMTHSTANDING 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 ADDL JNSD SUER WVD POLICY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X X GL000954837 12/01/2016 12/01/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X I OCCUR 4REM SES7Ea occur ence) $ 100,000 X GE MED EXP (Any one person) $ 5,000 Per Proj Agg PERSONAL 8 ADV INJURY $ 1,000,000 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY L PE� LOC PRODUCTS - COMP /OPAGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY X 12/01/2016 12/01/2017 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X r— X ANY AUTO X CA100007833 -01 BODILY INJURY (Per person) $ ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ PIP $ 10,000 B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE UMB00098587 12/01/2016 12/01/2017 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED I X RETENTION $ 10000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1 N ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A X } PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ C D POLLUTION EQUIPMENT FLOATER 151521322 16603842B003 11/02/2016 12/01/2016 11/02/2017 12/01/2017 LIMITS 2,000,000 LIMITS 300,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) BID ONLY /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 A! ''' "'` *30 days notice of cancellation,10 days for nonpayment s. ) rr-F Q:f "- ,, ■%,r' CERTIFICATE HOLDER CANCELLATION CITYCL2 City of Clearwater Attn: City Clerk 100 S. Myrtle Ave. #220 Clearwater, FL 33758 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 ACORD 25 (2014/01) © 1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD