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JEFFORDS ST CHANNEL GABIONS PROJECT - 11-0009-EN - CERTIFICATE OF LIABILITY INSURANCE (4)KEYST -1 OP ID: WD ,acoizo CERTIFICATE OF LIABILITY INSURANCE �—� DATE 06/19/2017 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: Case J. Fessler, AAI, CIC PHONE FAX (A/C, No, EXt): 727- 726 -3377 (A/C, No): 727- 725 -4698 E-MAIL Dss: 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. INR TYPE OF INSURANCE ADDESUBR JNSD WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD /YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY GL000954837 RFCE JUN tN. JUN 2 OFFICIAL RECORDS 2 2017 AND 12/01/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGES (RENTED PREMISES (Ea occurrence) 100,000 $ � X MED EXP (Any one person) $ 5,000 Per Proj Agg PERSONAL & ADV INJURY $ 1,000,000 GE 'L AGGREGATE POLICY OTHER: X LIMIT APPLIES /287 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 LEGISLATIVE CA100007833 -01 SRVCS DEPT. 12/01/2016 12/01/2017 COMBI eDtSINGLELIMIT $ 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? n (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) RE: Jeffords Channel Improvements Project #11- 0009 -EN CERTIFICATE HOLDER CANCELLATION I CITYCLE City of Clearwater Attn: Cathy Tefft 100 South Myrtle Ave., #220 Clearwater, FL 33756 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 � f 7_e id, - ACORD 25 (2014/01) ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD