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CERTIFICATE OF LIABILITY INSURANCE (5) KEYSEXC-01 BWARNER F �AT E{M MfDDYY YYy T IC T F LIABILITY I 1 111812016 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( ),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pol cy(ies)must have ADDITIONAL INSURED provisions or 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 endorseml CONTACT PRODUCER _NAk1F .___ ..... ---- --—_ ASSOCIATES AGENCY,INC. PHONE 813 988-1234 FAX 81 11470 N 53rd St INC,No_,Extl (—_ ) (Arc No);( 3)988---19$9 E Ia7AIL certs assoolatesins com Temple Terrace,FL 33617 A _.. ..... - _.___ INSURERn AFFORDING COVERAGE---- NAIL# ---- --.....-- ----------.__ ....._.------ INSURER A:American Interstate Insurance Co .31895 iNSURED INSURER B: Keystone Excavators,Inc. INSURER c 371 Scarlet Blvd. INSURER D: Oldsmar,FL 34677 1 INSURER E; 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 INDICATEC NOTWITHSTANDING ANY REQUIREMENT TER I 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 LAID CLAIMS. _ - _. ,.. ,IN SUBR' POLICY EFF POLICY EXP I.. ------- _.----- -.—._....._...---- -......------._._.. LTR TYPE OF INSURANCE I D __ D POLICY NUMBER LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S — — CLAIMS MADE OCCUR _._. . .—...._. ......--.__-- `DAMAGE TO RENTED PRFM SEJF� sSC.�Ge G----------- - ..J ............. ......... .............. N1ED EXF An cne _ersan_ $ PERSONAL.&ADV INJURY GEN'L AGGREGATE:LIMIT APPLIES PER GENERAL AGGREGATE POLICY j ry' _OC PRODUCTS-COMP;OP AGG OTHER: AUTOMOBILE LIABILITY ',r N j j i COMTNED SINGLE LIMIT i [a accident!. ANY AUTO B[]DILY IMJLY ,,persor+ -- OWNED SCHEDULED I -' AUTOS ONLY I AUTOS BODILY INJURY Seer acciderti i � HIRED � NUON•PNED - T -- .... -_- S PROPERTY DAMAC,E. ALJTOSONLY _----_a Ak1T© ONLY ( _ Pera cid2'�' .�_.-.. UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS MADE' AGGREGATE DED j RETENTION S A WORKERS COMPENSATION ,. j PER OTH- AND EMPL OYERS LIA BI,LITY YIN 16-427 1210112016. 12.10112017 STA ftiTE E[P -- 1 004,4100 %F C�R;N!EM5 R EXCL,IDR_E? `IVr N f A C L EACH EA Eh°LCYEE' _,..._.. _._.._..'...,,_ {s�anrtam y to NFi 1 000 000 If yes.descr be undo — -- -- 1,004,{144 DESCRIPTION OF OPERATIONS b=11)w I E.L.DISEASE-POLICY LIMIT I ' DESCRIPTION OF OPERATIONS i L,OCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE. Cif of Clearwater Engineering Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City g B p ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 4748 Clearwater,FL 33758 AUTHORIZED REPRESENTATIVE ACORD 25(2016103) O 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD