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SAND KEY PARKING LOT - 15-0014-EN - CERTIFICATE OF LIABILITY INSURANCE KEYST-1 OP ID:SP DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 03/10/2017 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 NAME: Case J. Fessler,AAI, CIC Fessler Agency-Clearwater PHONE 727-726-3377 FAX No: 727-725-4698 3165 N McMullen Booth Road G-2 A/C No Ext Clearwater,FL 33761-2020 aI oRless: cfessier@fessieragency.com J.Fessler,AAI,CIC INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:National Trust 20141 INSURED Keystone Excavators, Inc. INSURER B:National Trust 20141 371 Scarlet Blvd. Oldsmar,FL 34677 INSURER C:Allied World Assurance Co. 19489 INSURER D:Travelers Insurance Company 40282 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 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 ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR GL000954837 12/01/2016 12/01/2017 DAMAGES( RENTED 100000 PREMISES Ea occurrence $ r MED EXP(Any one person) $ 5,000 X Per ProjAgg PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ECT [::] LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident) B X ANY AUTO CA100007833-01 12/01/2016 12/01/2017 BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident PIP $ 10,00 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 B EXCESS LAB CLAIMS-MADE UMB00098587 12/01/2016 12/01/2017 AGGREGATE $ 5,000,000 DED X RETENTION$ 10000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROP RIETOR/PARTN ER/EXEC UTIVE E.L.EACH ACCIDENT $ OFFICER/M EMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C POLLUTION 51521322 11/02/2016 11/02/2017 LIMITS 2,000,000 D EQUIPMENT FLOATER 66038428003 12/01/2016 12/01/2017 LIMITS 300,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project#15-0014-EN CERTIFICATE HOLDER CANCELLATION CITYCL6 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. Engineering Dept. AUTHORIZED REPRESENTATIVE Sand Key Beach Parking Lot 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