CERTIFICATE OF LIABILITY INSURANCE (9)� � DATE (MMIDD/YYYY)
�°'�O CERTIFICATE OF LIABILITY INSURANCE o4,z�,zo,z
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
Marsh USA Inc.
TWO LOGAN SQUARE
PHILADELPHIA,PA 19103-2797
Attn: Healthcare.AccaintsCSS@marsh.comlFAX: 212 948-1307
100607-PRIM-CRIME-12•13
INSURED
CIGNA CORPORATION
900 COTTAGE GROVE ROAD
BLOOMFIELD, CT 06002
PHONE
E:
National Union Fire Insurance Co. of Pittsburgh, Pa �19445
COVERAGES CERTIFICATE NUMBER: CLE-003404728-16 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 . 7ypE OF INSURANCE ADDL SUBR POLICY EFF POIICY EXP ��M��
LTR POLICV NUMBEH MM/DDMIYY MM/DD/YYYY
GENERAL LIABILITY EACH OCCURRENCE $
OAMAGET RENTED
COMMERCIAL GENERAL LIABILITY ���� PREMISES E curc nc $
CLAIMS-MADE � OCCUR MED EXP (M ane person) $
PERSONAL & ADV INJURY $
MAY 0 3 2012 GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $
POLICY PR� LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
,�t,A�/� p�� Ea ac id nt
HNY AUfO �„�L7{'+OC�'1117 � Si��� D�� BODIL'f INJURY (Fer personj $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS
HIRED AUTOS NON•OWNED PROPERTY DAMAGE $
AUTOS Per accident
$
UMBRELLA LIAB OCCUR EACH OCCUflRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS' LIABILITY Y� N
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? � N / A
(Mandatory in NH) E.L. DISEASE • EA EMPLOYE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE • POLICY LIMIT $
A CRIME ( FIDELITY 018183396 04130I2012 0413012013 LIMIT $5,000,000
DEDUCTIBLE $2,500,000
DESCRIPTION OF OPERATION5/ LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
CERTIFICATE HOLDER
CITY OF CLEARWATER, FLORIDA
ATTN: CITY CLERK
PO BOX 4748
CLEARWATER, FL 33758
ACORD 25 (2010/05)
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 REPRESENTATIVE
of Marsh USA Inc.
Manashi Mukhery'ee -,�'rt,��n.m�a� r,'�+t�-itw,s�-e�s-
� 1988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
-.
ACORO�
`....�i
AGENCY
Marsh USA Inc.
POLICY NUMBER
CARRIER
AGENCY CUSTOMER ID: 100607
LOC #: Philadelphia
ADDITIONAL REMARKS SCHEDULE
NAIC CODE
NAMEDINSURED
CIGNA CORPORATION
900 COTTAGE GROVE ROAD
BLOOMFIELD, CT 06002
EFFECTIVE DATE:
Page 2 of 2
ACORD 101 (2008/01) 02008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
�
0005754 SP 0132 -001-P05756-I
CITY OF CLEARWATER, FLORIDA
Al?N: CITY CLERK
PO BOX 4748
CLEARWATER, FL 33758 �
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