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CERTIFICATE OF LIABILITY INSURANCE (4)6/29/ M/DD/YYYY) AC RO D® CERTIFICATE OF LIABILITY INSURANCE 0DATE (M 06/29!2010 PRODUt:ER 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-C I G NA-CAS-10-11 INSURED CIGNA CORPORATION TWO LIBERTY PLACE, TL15B 1601 CHESTNUT STREET PHILADELPHIA, PA 19192-2438 COVERAGES INSURERS AFFORDING COVERAGE ! NAIC # INSURER A: ACE American Insurance Company 22667 INSURER B: American Guarantee & Liability Ins Co 26247 INSURER C: Indemnity Ins Co Of North America 43575 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 LTR AUU INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE(MWDD(YYYY) POLICY EXPIRATION DATE(MMIDDIYYYY) LIMITS A GENERAL LIABILITY HDOG25519036 07/01/2010 07/01/2011 EACHOC_CURRENCE _ 1000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 1,000,000 _ ._ -..._? . ... . ::D..CLAIMS NTADE 5K OCCUR- ." -- .._... _ .-.. ... .. ED E?(P(Any one. person) VIED .. 5,000 $ .. ... . . PERSONAL & ADV INJURY 1 000 000 GENERAL AGGREGATE , , $ 3,000,000 GENERAL AGGREGATES L'O'- IT APPLIES PER PRODUCTS - COMP/OP AG - $ 1 '000 ,000 X POLICY JECT LOC A AUT OMOBILE LIABILITY ISAH08590412 07/01/2010 07/01/2011 COMBINED SINGLE LIMIT I 000 000 $ 1 X ANY AUTO E IV (La accident) . , , ALL OWNED AUTOS ._..._- BODILY INJURY - - "_ ( Per person) SCHEDULED AUTOS HIRED AUTOS I'U _ G` ?Cl?t't u I BODILY INJURY $ NON-OWNED AUTOS ?J (J J (Per accident) ti PROPERTY DAMAGE P id $ ( er acc ent) GA RAGE LIABILITY r,,, 9 AUTO ONLY - EA ACCIDENT $ .... - ANY AUTO I OTHERTHAN EAACC $ - AUTO ONLY: $ AGG B EXCESS /UMBRELLA LIABILITY AUC967096602 07/01/2010 07/01/2011 EACH OCCURRENCE _ $ 5,000,000 X OCCUR CLAIMS MADE AGGREGATE $ 5 000,000 "` , $ DEDUCTIBLE - $ RETENTION $ C WORKER EMPLOYE S COMPENSATION AND RS' LIABILITY WLRC46137073 (AOS) 07/01/2010 07/01/2011 X WC STATU- OTH- A SCFC46137115 (WI) 07/01!2010 07101/2011 000 $ 1 000 1 N ANY PROPRIETOR/PARTNER/EXECUTIVE Y MA WLRC46137036 CA 07/01/2010 07/01/2011 .L. EACH ACCIDENT , , A - OFFICEPJMEM13ER EXCLUDED? , ) ( N WLRC46136998 (WV) 07/01/2010 07/01/2011 .L. DISEASE - EA EMPLOYE $ 1,000,000 A (Mandatory in If yes, describe under NH) L DISEASE -POLICY LIMIT 000 $ 1 000 V I SPECIAL PROVISIONS below . . , , A EXCESS WCUC46137152 (OH) 07/01/2010 07/01/2011 LIMIT $1,000,000 WORKERS COMPENSATION SIR $1,000,000 DESCRIPTION OF OPERA I IONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER CITY OF CLEARWATER ATTN: CITY CLERK PO BOX 4748 CLEARWATER, FL 33758 ACORD 25 (2009/01) CLE-002343600-05 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATNES. kLITNOR of Mar12Ep gEplftE5ENTATIVE of Marsh U Anc. -r Katey E. Jones ©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, ?..._...-?..._..?,r.nd"?i` ? caverag?'?1'Ft57d?d-6yTfte pt?'Ii?Pes iisted'tti Y?dYt-: •. _._.._._. r7nnnini 1 ADDITIONAL INFORMATION CLE-002343600-05 DATEIMM/DDrfY) 06/29/2010 MARSH USA Inc. TWO LOGAN SQUARE PHILADELPHIA, PA 19103 Attn: Healthcare.AccountsCSS@marsh.com/FAX: 212 948-1307 100607-CIG NA-CAS-10-11 INSURED CIGNA CORPORATION TWO LIBERTY PLACE, TL15B 1601 CHESTNUT STREET PHILADELPHIA. PA 19192-2438 INSURERS AFFORDING COVERAGE INSURER F: INSURER G: INSURER H: INSURER I: NAIC # TEXT REQUIRED", AND WE WILL Katey E. Jones I!1- ITO O v CERTIFICATE HOLDER CITY OF CLEARWATER ATTN: CITY CLERK PO BOX 4748 CLEARWATER, FL 33758 MARSH USA INC. TWO LOGAN SQUARE PHILADELPHIA, PA 19103 ATTN: HEALTHCARE_ACCOUNTSCSSOMARSH.COM/ 023287 CITY OF CLEARWATER M-023287 ATTN: CITY CLERK PO BOX 4748 isi CLEARWATER FL 33758-4748 050720