CERTIFICATE OF LIABILITY INSURANCE (68)Alcotw- CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDD/YYYY)
12/02/2008
--------- ---
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Marsh USA Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
TWO LOGAN SQUARE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
PHILADELPHIA, PA 19103-2797 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Attn: Healthcare.AccountsCSS@marsh.com/FAX: 212 948-1307
100607-PRIMA-CRIME-08-10
INSURED
CIGNA CORPORATION ET AL
1601 CHESTNUT STREET
TWO LIBERTY PLACE
PHILADELPHIA, PA 19192
INSURERS AFFORDING COVERAGE NAIC #
INSURERA U.S. Specialty Insurance Co 29599
INSURER B: Axis Reinsurance Company 120370
INSURER C:
INSURER D:
INSURER E:
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NS ADD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR INSR DATE (MM/DDIYY) DATE (MM/DDIYY)
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES(Ea occurence
$
MED EXP (Any one person) $
- CLAIMS MADE -OCCUR
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
GENERAL AGGREGATE LIMIT APPLIES PER
PRO PRODUCTS - COMP/OP AG
POLICY
JECT l LOC
I
AUT OMOBILE LIABILITY
COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
ALL OWNED AUTOS BODILY INJURY $
(Per person)
SCHEDULEDAUTOS __ -
HIRED AUTOS
BODILY INJURY
$
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE
$
(Per accident) ?
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
$
ANY AUTO I
! - OTHER THAN EA ACC
I AUTO ONLY
AGG $
i ;
EXCESSIUMBRELLA LIABILITY - EACH OCCURRENCE $
' OCCUR ? CLAIMS MADE ?' AGGREGATE $
DEDUCTIBLE
`v
$
RETENTION $ `'•%f' '- _ ... -- -
WORKERS COMPENSATION AND WC STATU- 07H-
EMPLOYE RS' LIABILITY
E $
.L. EACH ACCIDENT
ANY PROPRIETOR/PARTNER/EXECUTIVE
$
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE
If yes, describe under
L
DISEASE - POLICY LIMIT
$
SPECIAL PROVISIONS below .
.
A . OTHER U70847038 12/01/08 03/30/10
CRIME / FIDELITY (50% Participation) LIMIT $5,000,000
B LOSS DISCOVERED RNN744451/01/2008 12/01/08 03/30/10 SIR/ DEDUCTIBLE $2,500,000
(50% Participation)
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER CLE-001788375-05 CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
CITY OF CLEARWATER, FLORIDA EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
ATTN: CITY CLERK 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
PO BOX 4748
CLEARWATER, FL 33758 BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND
THE INSURER, ITS AGENTS OR REPRESENTATIVES.
UPON
?tE
AUO
ofTMeBh USA IrIC.SENTATNE
Mary Radaszewski
Ak.UKLI 2O tLUUI/UO) 0 ACOKU COKPOKA11 ION 1988
IMPORTANT
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 Certificate of 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.
Reverse of Paae 1
ADDITIONAL INFORMATION
PRODUCER
Marsh USA Inc.
TWO LOGAN SQUARE
PHILADELPHIA, PA 19103-2797
Attn: Healthcare.AccountsCSS@marsh.com/FAX: 212 948-1301
100607-PRIMA-CRIME-08-10
INSURED
CIGNA CORPORATION ET AL
1601 CHESTNUT STREET
TWO LIBERTY PLACE
PHILADELPHIA, PA 19192
CLE-001788375-05
INSURERS AFFORDING COVERAGE
INSURER F:
INSURER G:
INSURER H:
I
INSURER I-
DATE (MWDD/YY)
12/02/2008
NAIC #
TEXT
"IF EVIDENCE OF COVERAGE IS NO LONGER REQUIRED, KINDLY RETURN THE CERTIFICATE MARKED "NO LONGER REQUIRED", AND WE WILL
ADJUST OUR FILES ACCORDINGLY."
"THIS CERTIFICATE SUPERSEDES ALL PREVIOUS FIDELITY/ CRIME CERTIFICATES."
CERTIFICATE HOLDER
CITY OF CLEARWATER, FLORIDA
ATTN: CITY CLERK
PO BOX 4748
CLEARWATER, FL 33758
Mary Radaszewski
2