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POND SEDIMENT REMOVAL AT MOCCASIN PARK - 17-0014-EN - CERTIFICATE OF LIABILITY INSURANCE
ACCORD►.. CERTIFICATE OF LIABILITY INSURANCE KEYST -1 OP DATE(MMIDDIYYYY) 04111/2017 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 INSURED Keystone Excavators, Inc. 371 Scarlet Blvd. Oldsmar, FL 34677 CONTACT Case J. Fessler, AAI, CIC (P" A/CC. No, Ext): 727- 726 -3377 ASS: cfessler(r3'tiessleragency,com INSURER(S) AFFORDING COVERAGE INSURER A: National Trust INSURER B : National Trust FAX (ac, Noy 727 -725 -4698 NAIC I 20141 20141 INSURER C : Allied World Assurance Co. 19489 INSURER D : Travelers Insurance Company 40282 INSURER E : INSURER F COVERAGES CERTIFICATE 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 ADDL SUHR; TYPE OF INSURANCE ! INSD WVD I POLICY NUMBER POLICY EFF IMM DDIYYYYI POLICY EXP 1MMIDOIYYYY UMITS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE A X COMMERCIAL GENERAL LIAEILflY OCCUR X X GL000954837 ' 12/01/2016 12/01/2017 EACH OCCURRENCE S 1,000,000 I CLAIMS -MADE � X DAMAGE TO RENTED PREMISES (Ea ocainence) S 100,000 MED EXP (Any one person) S 5,000 ® Per Prof Agg PERSONAL & ADV INJURY s 1,000,000 GEN ■ L AGGREGATE LIMIT APPLIES a PER GENERAL AGGREGATE S 2,000,000 POLICY I J OTHER: LOC i PRODUCTS - COMP/OP AGO S 2,000,000 S B AUTOMOBILE U LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS ' X X CA400007833 -01 SCHEDULED AUTOS AUTOSWNED 12/01 /2018' 12/01/2017 COMBINED nISINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) S MO BODILY INJURY (Per accident) S U X DAMAGE Per accident S PIP s 10,000 B UMBRELLA LIAR EXCESSLIAB X OCCUR CLAIMS-MADE 'UMB00098587 12/01 /2016 12/01/2017 EACH OCCURRENCE S 5,000,000 ■ AGGREGATE $ 5,000,000 ■ 0 X RETENTION S 10000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERJEXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS YIN . NIA H- PERTUTE 0 1 E .. EACH ACCIDENT : _._ S I I E DISEASE - EA EMPLOYEE S - -. - - -, below �''''' - I E.L. DISEASE - POLICY LIMIT .- ..- S _,...._ _ ..............� . . C D POLLUTION QUIPMENTFLOATER 51321322 6603842B003 11/02/2016 12/01/2016 11/02/2017 12/01/2017 lI.IMITS UMITS 2,000,000 300,000 DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached I more space is required) Project # 17- 0014 -EN City of Clearwater is included as additional insured on the General Liability & Auto Liability. Umbrella policy follows form. Waiver of Subrogation is included for the additional insured on the General Liability; Auto Liability CERTIFICATE HOLDER CANCELLATI ACORD 26 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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. 100 South Myrtle Avenue AUTHORIZED REPRESENTATIVE C # v ... ., 7. e. 4 4 i A - - - - I Clearwater, FL 33756 ACORD 26 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD