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CERTIFICATE OF LIABILITY INSURANCE (6)KEYST -1 OP ID: WD ,acoRO CERTIFICATE OF LIABILITY INSURANCE `—.------ DATE (MM /DD/YYYY) 06/19/2017 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 NAME: ACT Case J. Fessler, AAI, CIC PHONE FAX (A/C, No, Ext): 727-726 -3377 (q/C, No): 727 4254698 E-MAIL ESS: 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. 19489 INSURER D : Travelers Insurance Company 40282 INSURER E : INSURER F : X 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 LTR TYPE OF INSURANCE ADDS INSD SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X X GL000954837 RECENI'mv JUN 2 2 pp� 1� Cr °FRO& RE 016 .� i— f...,' 2011 QRL)s J'',I') 12/01/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 X Per Proj Agg PERSONAL & ADV INJURY $ 1,000,000 GE 'L AGGREGATE POLICY OTHER: X LIMIT APPLIES jE PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 $ B AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X NON SCHEDULED AUTOS -OWNED AUTOS X X Y GISLAI iVE SRVCS CA100007833 -(t r DE.,r d, 12/01/2016 12/01/2017 COMBINED SINGLE LIMIT CO accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ PIP $ 10,000 g X UMBRELLA LIAB EXCESS UAB X OCCUR CLAIMS -MADE UMB00098587 12/01/2016 12/01/2017 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED X RETENTION $ 10000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below / N N / A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ C D POLLUTION EQUIPMENT FLOATER 51521322 6603842B003 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.lncludes Separation of Insured *30 days notice of cancellation,10 days for nonpayment CERTIFICATE HOLDER CANCELLATION I 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 64-(-- 7. e 4 a , - - ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD KEYST -1 OP ID: WD ACC,R EY CERTIFICATE OF LIABILITY INSURANCE DATE 06 /119 /9/22017 017 ) 06 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: Case J. Fessler, AAI, CIC PHONE FAX (A/C, No, Est): 727-726-3377 (A/C, No): 727 - 7254698 E-MAIL DE 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. 19489 INSURER D : Travelers Insurance Company 40282 INSURER E : INSURER F : X 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 LTR TYPE OF INSURANCE ADDL INSD SUER WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY GL000954837 RECEN'EL3 JUN 2 2 201 /01/2016 12/01/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 X Per Proj Agg PERSONAL & ADV INJURY $ 1,000,000 GE 'L AGGREGATE POLICY OTHER: X LIMIT APPLIES 118-. PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS ( OFFICTAI. fit. -�" CA1000078pa T SW LMSLAI wE SIIV r AHD _ U2.441 _.r_ 4.1 U2.4 1 a6 1201/0217 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ 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 X RETENT ON $ 10000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? I (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ C D POLLUTION EQUIPMENT FLOATER 51521322 6603842B003 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) CERTIFICATE HOLDER CANCELLATION CITYCL6 City of Clearwater Engineering Department Attn: Construction Office PO Box 4748 'Clearwater, FL 33758 -4748 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 6114--- 7...cm,-- ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD KEYST -1 OP ID: WD '4� Rte# CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) 06/19/2017 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 J. Fessler, AAI, CIC CONTACT Case J. Fessler, AAI, CIC PHONE FAX (A/C. No. EXn:727-726 -3377 (A/C, No): 727 - 725 -4698 al DReSS: 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. 19489 INSURER D : Travelers Insurance Company 40282 INSURER E : INSURER F : CLAIMS -MADE 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 TYPE OF INSURANCE AD .L INSD SUBR WVD POLICY NUMBER POLICY EFF MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X X GL000954837 J i g N Ai � U OFFICIAL RECORDS IFGISIA E, 2 SRVrc r � 2/0112016 �n � � U AND L :,) 12/01/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE EMI TO SES (Ea a occurrence) PREMISES ccu $ � 100 000 MED EXP (Any one person) $ 5,000 X GEN'L Per Proj Agg PERSONAL & ADV INJURY $ 1,000,000 AGGREGATE POLICY OTHER: X LIMIT APPLIES jE PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OPAGG $ 2,000,000 $ B AUTOMOBILE X X _ LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUOS X X CA100007833 -01 12/01/2016 12/01/2017 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ 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 X RETENTION $ 10000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETOR /PARTNER/EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below / N N / A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ C D POLLUTION EQUIPMENT FLOATER 51521322 6603842B003 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) Certificate holder is included as additional insured on the GL & Auto Liability *Limited Professional(Contractors E &O)Policies are primary & non- contnbutory.Waiver of Subrogation is included on the GL; Auto Liability Includes Separation of Insured *30 days notice of cancellation,10 days for nonpayment CERTIFICATE HOLDER CANCELLATION CITYCL9 City of Clearwater Engineering Dept. Lisa Bayly 100 S. Myrtle Ave (Clearwater, FL 33756 -5520 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