CERTIFICATE OF LIABILITY INSURANCE (7)ACQR" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/Dp/VVYY)
04/26/2011
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(ies) 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
NAM
Marsh USA Inc. PHONE FAX
TWO LOGAN SQUARE A/C No :
PHILADELPHIA, PA 191032797 E-MAIL
ADDRESS:
Attn: Healthcare.AcmunlsCSSQmarsh.com/FAX: 212 948-1307 PR
ODUCER
CUSTOMER ID
100607-PRIM-CRIME-11-12 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A, National Union Fire Insurance Co. of Pittsburgh, Pa 19445
CIGNA CORPORATION AND ITS SUBSIDIARIES
Y P
A
TL1
B INSURER B :
TWO LIBERT
L
CE,
5
1601 CHESTNUT STREET INSURER C :
PA 19192-2438
PHILADELPHIA
, INSURER D
INSURER E :
INSURER F :
r`_r1VFRAn9C rFRTIFlf ATF NIIMRFR- CLL-003019M-13 REVISION NUMBER: 2
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.
INSR L TYPE OF INSURANCE DL SUER
WVD POLICY NUMBER MMPOLICY EFF
IDD/YYYY POLICY EXP
MM/DD/YYYY
LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY A E ORE TEDcurren
PREMISES Ea occe
$
CLAIMS-MADE r_1 OCCUR MED EXP (An one person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $
POLICY
1 JE oi E-1 LOC
L
$
AUT -
OMOBILE LIABILITY COMBINCO SINGLE LIMIT
(E
id
t) $
a acc
en
ANY AUTO BODILY INJURY (Per person) $
ALL OWNED AUTOS BODILY INJURY (Per accident) $
SCHEDULED AUTOS
HIRED AUTOS 2 0 1
PROPERTY DAMAGE
(Per accident)
$
NON-OWNED AUTOS REC q g? ` ?
ORDS $
LEGISLATIVE Z' Z $
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $
WORKERS COMPENSATION
' WC STATU• OTH-
LIABILITY Y / N
AND EMPLOYERS
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$
?
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) N/A
E.L. DISEASE - E4 EMPLOYE
$
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$
A
C
_ __ _
I
017666975
?
0413012011
04130/2012 LIMIT 5,000,000
Deductible 2,500,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
CFRTIFICATF HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITY OF CLEARWATER, FLORIDA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ATTN: CITY CLERK ACCORDANCE WITH THE POLICY PROVISIONS,
PO BOX 4748
CLEARWATER, FL 33758 AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Katey E, Jones V11 l?_ 1
®1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
ADDITIONAL INFORMATION
PRODUCER -- -- -
Marsh USA Inc.
TWO LOGAN SQUARE
PHILADELPHIA, PA 19103-2797
Attn: Healthcare.AccountsCSS@marsh.com/FAX: 212 948-1307
100607-PRIM-CRIME-11-12
INSURED
CIGNA CORPORATION AND ITS SUBSIDIARIES
TWO LIBERTY PLACE, TL15B
1601 CHESTNUT STREET
PHILADELPHIA, PA 19192-2438
CLE-W3019838-13
INSURERS AFFORDING COVERAGE
INSURER G:
INSURER H:
INSURER 1:
J:
DATE (MMIDDIYY)
0412612011
NAIC #
rExT _
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 I CRIME CERTIFICATES"
CERTIFICATE HOLDER
CITY OF CLEARWATER, FLORIDA
ATTN: CITY CLERK
PO BOX 4748
CLEARWATER, FL 33758
Katey E. Jones i / _ _?
0010470 5P 0107 -C01-P10475.1
CITY OF CLEARWATER, FLORIDA
ATTN: CITY CLERK
PO BOX 4748
CLEARWATER, FL 33758 Is-