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CERTIFICATE OF LIABILITY INSURANCE (3)CERTIFICATE OF LIABILITY INSURANCE 0DATE (MWD 4/30/2010 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 19103-2797 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Attn: Healthcare.AccountsCSS@marsh.com/FAX: 212 948-1307 100607-PRIM-CRIME-10-11 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA National Union Fire Insurance Co. of 19445 ITS SUBSIDIARIES CIGNA CORPORATION AND TWO LIBERTY PLACE, TL15B INSURER B: 1601 CHESTNUT STREET INSURER C: PA 19192-2438 PHILADELPHIA , INSURER D: INSURER E: Tl .... 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 LTR ADD' INSR TYPE OF INSURANCE m^ POLICY NUMBER w ^ POLICY EFFECTIVE DATE (NIMODOrYYYY) POLICY EXPIRATION DATE (MMMDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO RENTED $ COMMERCIAL GENERAL LIABILITY SES(Ea occurrence) PREM I CLAIMS MADE 7-1 OCCUR - - - "" - - - - , , MED EXP (Any one person) , $ PERSONAL & ADV INJURY $ T _ GENERAL AGGREGATE $ ... w GENERAL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AG -? POLICY PE O LOG AUT OMOBILE LIABILITY ®E n COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO ALL OWNED AUTOS BODILY INJURY $ SCHEDULEDAUTOS 10 2090 (Per person) MAY HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS ECORDS D (Per accident) f....r OFFICIAL Ct /L R RVCS D ?y TT PROPERTY DAMAGE (Per accident) $ _?._ LGCGIJ I.J'? S GARAGE LIABILITY AUTO ONLY - EAACCIDENT $ ANY AUTO OTHERTHAN EA ACC $ AUTO ONLY: $ AGG EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR E:1 CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND ' WC STATU- OTH ftT LIABILITY EMPLOYERS $ ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N .L. EACH ACCIDENT ` OFFICER/MEMBEREXCLUDED? .L DISEASE - EA EMPLOYE -- $ L (Mandatory in NH) IF yes, describe under _L. DISEASE - POLICY LIMIT $ SP CIAL.PROVISIONS below - " OTHER A CRIME/FIDELITY 018176393 04/30/2010 04/3012011 LIMIT 5,000,000 Deductible 2,500,000 DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CFRTIFICATF 14nl nFR rl F_M?g4AA?9-11 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. U PO N p?pp ON tr?} ? U M8R1 USA,% 1NTATNE .7.i lz ,O?Lu d Mary Radazzewski ACORD 25 (2009/01) ©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. ADDITIONAL INFORMATION CLE-002344422-11 DATEIMM/DDfYY) w - 04/30/2010 PRODUCER u? __.. • Marsh USA Inc- TWO LOGAN SQUARE PHILADELPHIA, PA 19103-2797 Attn: Healthcare.AccountsCSS@marsh.com/FAX: 21 2 948-1307 100607-PRIM-CRIME-10-11 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER F: y CIGNA CORPORATION AND ITS SUBSIDIARIES INSURER G: TWO LIBERTY PLACE, TL15B 1601 CHESTNUT STREET _., -? _ • _ INSURER H- PHILADELPHIA PA 19192 2438 , - - -- -_ - m -- INSURER L 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 AUTHOARQEQ 6EPRESENTATNE Ja ?.,,•d,? Mary Radaszewski MARSH USA INC. TWO LOGAN SQUARE PHILADELPHIA, PA 19103-2797 ATTN: HEALTHCARE.ACCOUNTSCSS@MARSH.COM/ 032663 CITY OF CLEARWATER, FLORIDA M-032663 ATTN: CITY CLERK PO BOX 4748 191 CLEARWATER FL 33758-4748 066446