CERTIFICATE OF LIABILITY INSURANCE (84)
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CERTIFICATE OF LIABILITY INSURANCE
/YYYn
09
DATE (MWOD
09
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- - - 06/2 ps,2a/20
,20
PRODUCER THIS CERTIFICATION 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 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Attn: Healthcare.AccountsCSS@marsh.com/FAX: 212 948-1307
100607-CIGNA-CAS-09-10 INSURERS AFFORDING COVERAGE NAIC #
INSURED T
O
PORATION ET AL INSURER A: ACE American Insurance Company 22667
°-- -
CIGNA C
R
1601 CHESTNUT STREET INSURER B: American Guarantee & Liability Ins Co 26247
TWO LIBERTY PLACE
INSURER C: Indemnity Ins Co Of North America
n.c
43575
PHILADELPHIA, PA 19192
^•.• ._
INSURER D:
INSURER E:
rnvicewr_cc
-- ----- - -----
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. _
INS ADD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR INSR DATE(MMMD/YYYV) OATE(MWlDD/YYYY)
GENERAL LIABILITY
HDOG24932837
07101/2009
07101!2010 EACH OCCURRENCE 1 QQ? QOp
4 DAMAGE T RENTED
$ 1
000
000
X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence ,
,
-CLAIMS MADE 1.OCCUR .:
._...
.. _ - MED _ EXP (Any one person) _
$- 5,000
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 3,000,000
GENERAL AGGREGATE LIMIT APPLIES PER
P
RO PRODUCTS - COMP/OP AG 1,000,000
X POLICY
T LOC
JEC
A AUT OMOBILE LIABILITY ISAH08580017 07/01/2009 07/01/2010
COMBINED SINGLE LIMIT
$ 1
000
000
X ANY AUTO (Ea accident) ,
,
ALL OWNED AUTOS
SCHEDULEDAUTOS
II r
?? LS
a , I' i I
L'? IJ L;
?
' BODILY INJURY
(Per person) $
M
HIRED AUTOS . ? ---
BODILY INJURY
$
NON-OWNED AUTOS (Per accident)
Ju ,
PROPERTY DAMAGE
r
: ? ?
,• (Per accident) $
,,
, ,_
GARAGE LIABILITY -••• •-- -,^ AUTO ONLY - EA ACCIDENT $
ANY AUTO LEGI I-1 ITJE.-. ..- OTHER THAN EAACC $
AUTO ONLY.
AGG $
EXCESS / UMBRELLA LIABILITY AUG967096601 07/01/2009 07/01/2010 EACH OCCURRENCE $ 5,000,000
B X OCCUR CLAIMS MADE AGGREGATE $ 5,000,000
$
DEDUCTIBLE $
RETENTION S
C WORKERS COMPENSATION AND WLRC45700495(AOS) 07101/2009 07/01/2010 X WCSTAru- OTH-
EMPLOYERS' LIABILITY SCFC45700483 (WI) 07/01/2009 07/01/2010 EACH ACCIDENT
L 000
000
$ 1
A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 7
/2010 .
. ,
,
WLRC45700471 (CA) 07/01/2009 /01
0
A
F7N
WLRC45700513 (WV)
07/01/2009
07/01/2010
L. DISEASE - EA EMPLOYE
El, DI
SEASE
$ 1,000,000
-
A` ) yes,
SPECIAL PROVISIONSbees?eribe under E.L. DISEASE - POLICY LIMIT $ 1,000,000
OTHER -- - _ _ - . ._ _ ...._ .. .. -.:. ..
A EXCESS WCUC45700501 (OH) 07/01/2009 07/01/2010 LIMIT $1,000,000
WORKERS COMPENSATION SIR $1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
CERTIFICATE HOLDER I" I F-I'1w-u- rnn-OR CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
CITY OF CLEARWATER 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
THHE INSURER, ITS AGENTS OR REPRESENTATIVES.
UPON
[?p
.jW. h 6SA 1r1C8ENTATNE
Mary Radasxewski
ACORD 25 (2009101) ®1998-2009 ACORD CORPORATION. All Rights Reserved
The ACORD name and logo are registered marks of ACORD
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
This Certificate of Insurance 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,
ektend or alter the coverage afforded by the policies listed thereon.
Acord 25
ADDITIONAL INFORMATION CLE-002343600-03 DATE(YY)
06/24/2009 2009
PRODUCER
MARSH USA Inc.
TWO LOGAN SQUARE
PHILADELPHIA, PA 19103
Attn: Healthcare.AccountsCSSQmarsh.com/FAX: 212 948-1307
100607-CIGNA-CAS-09-10
INSURERS AFFORDING COVERAGE
NAIC #
INSURED INSURER F'
CIGNA CORPORATION ET AL
1601 CHESTNUT STREET INSURER G'
TWO LIBERTY PLACE INSURER H'
-
PHILADELPHIA, PA 19192 INSURER I'
"IF EVIDENCE OF COVERAGE IS NO LONGER REQUIRED, KINDLY RETURN THE CERTIFICATE MARKED "NO LONGER REQUIRED", AND WE WILL
ADJUST OUR FILES ACCORDINGLY."
CERTIFICATE HOLDER
CITY OF CLEARWATER
ATTN: CITY CLERK
PO BOX 4748
CLEARWATER, FL 33758
Mary Radasze ki
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