2014 ANNUAL STORMWATER IMPROVEMENTS - 14-0004-EN - CERTIFICATE OF LIABILITY INSURANCE (4)KEYST -1
OP ID: WD
,a`COR� " CERTIFICATE OF LIABILITY INSURANCE
DATE (MM /DDmYY)
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
NAME Case J. Fessler, AAI, CIC
PHONE 727 -726 -3377 FAX No): 727 - 725 -4698
(A/C, No Ext):
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 NUM
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
I _ R
WVD
POLICY NUMBER
POLICY EFF
(MM /DD/YYYY)
POLICY EXP
(MM /DD/YYYY)
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
X
X
r 'Vr
GL000954837 L I
JUN 2 2
OFFIC,A. ! L RECORD
/''
1016
2017
l C ��i
CS i.-L-- '
12/01/2017
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE
X
OCCUR
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$ 10O 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
FM:
PER:
LOC
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP /OP AGG
$ 2,000,000
$
B
AUTOMOBILE
X
X
LIABILITYLKI
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
!
SCHEDULED
AUTOS
NON OWNED
AUTO- S
X
X
SK
CA100007833 -01
,
12/01/2016
I
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)
RE: 2014 Annual Stormwater Improvements Project #14- 0004 -EN /City of
Clearwater is included as additional insured on Project 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
i
CITYCLE
City of Clearwater
100 South Myrtle Ave.,
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
64, 7€4",,-
ACORD 25 (2014/01)
1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD