CERTIFICATE OF LIABILITY INSURANCE (6)C-Q/2 I
CERTIFICATE OF LIABILITY INSURANCE DAT 43/29DO?)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER-
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. 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).
PRODUCER CONTACT
i
k NAME:
Aon R
Services Central, Inc.
s PHONE
FAX
Philadelphia PA office (866) 283-7122
(847) 953-5390
(A/C. No. Ext : c. No.
one Liberty Place E-MAIL
1650 Market Street ADDRESS:
suite 1000
Philadelphia PA 19103 USA INSURER(S) AFFORDING COVERAGE NAIC #
INSURED INSURER A: Lexington Insurance Company 19437
Cigna corporation Et Al
1601 chestnut Street INSURER B:
Two Liberty Place INSURER C:
Philadelphia PA 19192 USA
INSURER D:
INSURER E:
INSURER F:
I..UVGKA%7CA Ur-K-11F1VAIIC NVNUMK: */LAJ41W4/VbfV . KtV1.7-IUN NUM151=111:
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS- Limits shown are as requested
00 LTR TYPE OF INSURANCE 1
LIMITS
USR9 WVD POLICY N (MM/0DNYYY1
GENERAL LIABILITY 1 ^ EACH OCCURRENCE
I, '-. ..•ra AMA TO R9NT9D
COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence
CLAIMS-MADE ? OCCUR?? n 4 ^ "LJD?? MED EXP (Any one Pelson)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
GEN'L AGGREG?A-TEI LIMIT APPLIES I-IPER: Crnfi AN PRODUCTS - COMP/OP AGG
POLICY I I M I I LOc
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED P SCHEDULED
AUTOS AUTOS
HIRED AUTOS NON-OWNED
AUTOS
UMBRELLA LAS HOCCUR
EXCESS LAB CLAIMS-MADE
OED RETENTION
WORKERS COMPENSATION AND
EMPLOYERS' LABILITY Y / N
ANY PROPRIETOR I PARTNER / EXECUTIVE
OFFICER/MEMBER EXCLUDED? NIA
(Mandatory in NH)
If Yes. dxscntre under
I A
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach
CERTIFICATE HOLDER
City of Clearwater
Attn: City Clerk
PO Box 4748
Clearwater FL 33758-4748 USA
tLLAL R .
E&o/Managed Care
SIR applies per policy to S & condi ions
ORD 101, Additional Remarks Schedule, If mom space Is requlred)
BODILY INJURY( Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE
EACH OCCURRENCE
AGGREGATE
E.L. EACH ACCIDENT
E.L. DISEASE-EA EMPLOYEE
E.L. DISEASE-POLICY LIMIT
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
POLICY PROVISIONS.
AUTHORIZED(` REEPPPRIESEN(T,A?T[IV/{E
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Cliff R?V 9Adl
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01988-2010 ACORD CORPORATION. Al rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD