CERTIFICATE OF LIABILITY INSURANCE (62)
I
i ACORQM
,_._.-
I PRODUCER
i MARSH USA Inc.
1WO lOGAN SQUARE
PHilADELPHIA, PA 19103
Attn: Healthcare.AccountsCSS@marsh.com/FAX: 212 948-1307
I OATE (MM/DDIYYYY)
06/27/2008
._--,-~
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
I INSURERS AFFORDING COVERAGE I NAlC #
------j---
1 INSURER A: Ace American Insurance Company 122667
lINSURERB-;-A~~~~~-G~arantee & Liability Ins Co 26247
! INSURER C: Indemnity Ins Co of North America 43575
CERTIFICATE OF LIABILITY INSURANCE
100607 -CIGNA-CAS-08-09
INSURED
CIGNA CORPORATION ET Al
1601 CHESTNUT STREET
1WO LIBERTY PLACE
PHilADELPHIA, PA 19192
1
~
u
INSURER D:
I
COVERAGES
· INSURER E'
- ---
UHE 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, HER,EIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND
CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NSRI ADD'~ POLICY EFFECTIVE I POLICY EXPIRATION
I LTR i INSR[ TYPE OF INSURANCE POLICY NUMBER DATE (MMIDD/YV) DATE (MMIDD/YY) LIMITS
1 A GENERAL LIABILITY > HDOG23.740102 107/01/08 07/01/09 EACH OCCURRENCE $
*- COMMERCIAL GENERAL LIABILITY ~~~~~~~~:~~:~ce) $
CLAIMS MADE [8] OCCUR MED EXP (Any one p-=rson~_ $
PERSONAL & ADV INJURY ,$
I I
I GENERAL AGGREGATE \$
I GENERAL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AG9$
I POLICY i' j~g,: Ii LOC
AUTOMOBILE LIABILITY
X ANY AUTO
ALL OWNED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
=1 ANY AUTO
EXCESS/UMBRELLA LIABILITY
:=J OCCUR CLAIMS MADE
A
ISAH07837173
107/01/09
I
RECEIVE~
AL 02 20001
OFFICiAL RECORDS A ~D
l"'''''''' \TIVJ: .......vr .... nl:Pi
1
,
1
OTHER THAN
AUTO ONLY:
07/01/08
COMBINED SINGLE LIMIT 1$
(Ea accident)
1$
BODILY INJURY
(per person)
I
I BODILY INJURY
(Per accident)
PROPERTY DAMAGE
(per accident)
AUTO ONLY - EA ACCIDENT $
EA ACC $
AGG $
$
$
$
$
1$
B
AUC967096600
07/01/09
EACH OCCURRENCE
AGGREGATE
107/01/08
I I DEDUCTIBLE
i H RETENTION $
I
C WORKERS COMPENSATION AND IWLRC43499038 (AOS) 07/01/08
EMPLOYERS'LIABILITY - [SCFC43499634 (WI)
A I ANY PROPRIETOR/PARTNER/EXECUTIVE 07/01/08
A I OFFICER/MEMBER EXCLUDED? WlRC43499610 (CA) 07/01/08
A If yes. describe under IWlRC43499609 (WV) 07/01/08
SPECIAL PROVISIONS below
OTHER EXCESS
A WORKERS COMPENSATION WCUC4349904A (OH) 07/01/08
07/01/09
07/01/09
07/01/09
07/01/09
.5DJ~T~Ws I _ I OJ~-
E.L. EACH ACCIDENT $
EL DISEASE - EA EMPLOYEE $
E.L. DISEASE. POLICY LIMIT! $
07/01/09
LIMIT
ISIR
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
1,OOO,00C
1,000,0001
5,000
,
1,OOO,oog
3,000,000
.-----------l
1,OOO,00q
I
1,OOO,OOQ
I
$
$
5,000,000
5,000,OOC
1,000,000
1,000,000
1,OOO,OOC
1,000,000
1,000,000
CERTIFICATE HOLDER ClE-001787570-02
1-:: OF CLEARWATER
I ATTN: CITY CLERK
PO BOX 4748
CLEARWATER, Fl 33758
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO DO SO SHAlLL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND
UPON THE INSURER,
A::llJig~lIf~ENTAT'VE
Mary Radaszewski
ITS AGENTS OR REPRESENTATIVES.
---tnt.l- ~"3ad d-a~y<--.--.:J.*-,~
ACORD 25 (2001108)
o ACORD CORPORATION 1988
IMPORT ANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Gertificateof Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer. and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
Acord 25 (2001/08)
Reverse of Page 1
ADDITIONAL INFORMATION CLE-001787570-02 ~E (MMIDDNY)
06/27/2008
---
PRODUCER
MARSH USA Inc.
TWO lOGAN SQUARE
PHILADELPHIA, PA 19103
Atln: Heallhcare.AccounlsCSS@marsh.com/FAX: 212 948-1307
100607 -CIGNA-CAS-08-09 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER F:
CIGNA CORPORATION ET Al INSURER G'
1601 CHESTNUT STREET
TWO LIBERTY PLACE INSURER H:
PHilADELPHIA, PA 19192
INSURER I:
TEXT
"IF EVIDENCE OF COVERAGE IS NO LONGER REQUIRED, KINDLY RETURN THE CERTIFICATE MARKED "NO lONGER REQUIRED", AND WE WILL I
ADJUST OUR FILES ACCORDINGLY."
I
I
I
CERTIFICATE HOLDER
CITY OF CLEARWATER
ATTN: CITY CLERK
PO BOX 4748
CLEARWATER, Fl 33758
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Mary Radaszewski
---h1t.L~'j ~ d k~.y<-"'-~*<'
Page 2
MARSH USA INC.
TWO LOGAN SQUARE
PHilADELPHIA, PA 19103
A TIN: HEAL THCARE.ACCOUNTSCSS@MARSH.COM/F
CITY OF CLEARWATER
ATIN: CITY CLERK
PO BOX 4748
CLEARWATER Fl 33758-4748
1..11...11.1...1.1.1.1..1..1..11...1.1..11..1..1..11..1.1.1..1
021758
M-021758
191
038024