CERTIFICATE OF LIABILITY INSURANCE/YYYY)
- - ^ DATE (MM f
x1L?CO/kD? 10
CERTIFICATE OF LIABILITY INSURANCE 03/01l20DD
Marsh US THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION
A 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
1601 CHESTNUT STREET
TWO LIBERTY PLACE
PHILADELPHIA, PA 19192
INSURER 8: Axis Reinsurance Company
INSURER C:
INSURER D:
INSURER E'
29599
COVERAGES
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 ICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
R ADD' TYPE OF INSURANCE POL
LIMITS
INSR
LT
DATE(MMIDO/YYYY( DATE (MMIDD/YYYY)
GENERAL LIABILITY
-
j
EACH OCCURRENCE
COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
F!REMISES(Ea ( occurrence)
_..
.....
.CLAIMS MADE .-_-OCCUR
MED XP (Any _
$
PERSONAL & ADV INJURY
GENERAL AGGREGATE -
$
GE NERAL AGGREGATE LIMIT APPLIES P —
ER
._.....
- ..
' PRO PRODUCTS - COMP/OP AGE
..
- $
POLICY I
LOC
J
ECT
..
.__..._
_..._........._?
AUT OMOBILE LIABILITY F OP`
r COMBINED SINGLE LIMIT
$
ANY AUTO (Ea accident)
ALL OWNED AUTOS f?Q oS]8 O? BODILY INJURY $
SCHEDULEDAUTOS RIB (Per person)
HIRED AUTOS
BODILY INJURY
$
?'?(
? 1„I
RECCR S AND Lj
P
id
NON-OWNED AUTOS U'1L (
er acc
ent)
LE MI5 TiVESM DEPT P
ROPERTY
DAMAGE
- --
det
(Per $
GA RAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: $
AGG
EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR n CLAIMS MADE AGGREGATE $
DEDUCTIBLE -....
. • $
1
.
-
`•" ,.-.
?.-?
RETENTION S
WORKERS COMPENSATION AND WC STATU- OTH-
EMPLOYERS' LIABILITY ORY11MI
ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N
OFFICER/M
R .L. EACH ACCIDENT $
EMBE
EXCLUDED?
L- DISEA5E_- EA EMPLOYE --
$
(Mandatory in NH) IF yes, describe under
SPECIAL PROVISIONS low
.L DISEASE_ POLICY LIMIT
$
A OTHER U708-47038 12/01/2008 04/30/2010
CRIME / FIDELITY (50% Participation) LIMIT $5,000,000
B LOSS DISCOVERED RNN744451/01/2008 12/01/2008 04/30/2010 SIR/ DEDUCTIBLE $2,500,000
(50% Participation)
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER CLE-002344422-08 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
UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTlIaRQEDREPREBENTATNE
Mary ffRaadUUaSSsAAzllewski
ACORD 25 (2009/01)
INSURERS AFFORDING COVERAGE
NAIC #
INSURER A: U-S. Specialty Insurance Co
9) 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,
-
extend or alter the coverage afforded by the policies listed -thereon.
Acord 25
ADDITIONAL INFORMATION CLE-002344422-08 DATE(MWODNY)
03/01/2010
PRODUCER --------
Marsh USA Inc.
TWO LOGAN SQUARE
PHILADELPHIA, PA 19103-2797
Attn: Healthcare.AccountsCSS@marsh.com/FAX: 212 948-1307
100607-PRIMA-CRIME-08-10 INSURERS AFFORDING COVERAGE NAIC #
INSURED
INSURER F:
CIGNA CORPORATION
1601 CHESTNUT STREET INSURER G: l
TWO LIBERTY PLACE INSURER H:
PHILADELPHIA
PA 19192
, INSURER I-
TEXT
CITY OF CLEARWATER, FLORIDA
ATTN: CITY CLERK
PO BOX 4748
CLEARWATER, FL 33758
QUIRED, KINDLY RETURN THE CERTIFICATE MARKED "NO LONGER REQUIRED", AND WE WILL
S FIDELITY/ CRIME CERTIFICATES."
Mary Radaszewski -
CERTIFICATE HOLDER
MARSH USA INC.
TWO LOGAN SQUARE
PHILADELPHIA, PA 19103.2797
ATTN: HEALTHCARE.AC000NTSCSS@MARSH.COM/
007022
CITY OF CLEARWATER, FLORIDA M-007022
ATTN: CITY CLERK
PO BOX 4748 191
CLEARWATER FL 33758-4748
014305
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