CERTIFICATE OF LIABILITY INSURANCE (10)CERTIFICATE OF LIABILITY INSURANCE I D07I05120��YYY)
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(s1.
PRODUCER
MARSH USA Inc.
TWO LOGAN SQUARE
PHILADELPHIA, PA 19103
Attn: Healtt�care.AccountsCSS@marsh.comlFAX: 212 948-1307
100607-CIGNA-CAS-12-13
INSURED
CIGNA CORPORATION
900 COTTAGE GROVE ROAD
BLOOMFIELD, CT 06002
PHONE
A: ACE American Ir�surance Canpany
B: American Guarantee & Liability Ins Co
�: Indemnity ins Co Of North America
22667
26247
43575
COVERAGES CERTIFICATE NUMBER: CLE-003505580-13 REVISION NUMBER:1
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 SUB.JECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TypE OF INSURANCE ADOL SUBR pOLICY NUMBER MM/ D/YYYY MM/DD/YYYY LIMITS
LTR
A GENERAL LIABILITY HDOG27010908 /'�� 1/2012 0710112013 EACH OCCURRENCE $ 1,000,000
X ��l r� � DAMA E RENTED 1,000,000
COMMERCIAL GENERAL LIABILITY �8� � PFEMISES Ea occurcence $
CLAIMS-MADE � OCCUR MED EXP (An one person) $ 5'�
JUL10 20 2 PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 3,000,000
GEN'L AGC'iREGATE LIMIT APPLIES PER: O�FI�If1L I�i�AJR S/'U `ILJ PRODUCTS - COMP/OP AGG $ 1,000,000
X POLICY PR� LOC $
A AUTOMOBILE LIABILITY ISAH08709 1 07I01I2013 COMBINED SINGLE LIMIT 1,000,000
E accident
X ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS PROPEFTY DAMAGE $
NON-OWNED Per accident
HIRED AUTOS AUTOS
$
B X UMBRELLA LIAB X OCCUR AUC967096604 07/0112012 07101/2013 EACH OCCURRENCE $ 10,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000
DED RETENTION $ $
C WORKERSCOMPENSATION WLRC47121334 (AOS) �%�01�2�12 �%��1�2013 X WC STATU- OTH-
AND EMPLOYERS' LIABILITY
A ANY PROPRfETOR/PARTNER/EXECUTIVE Y� N SCFC47121346 (WI) 07101I2012 0710112013 E.L. EACH ACCIDENT $ 1,000,000
A OFFICER/MEMBER EXCLUDED? � N�i4 WLRC47121322 (CA & MA) O7IOlI2O12 O7/Ol I2O13 1,000,000
(Mandatory in NH) E.L. DISEASE - EA EMPLOYE $
A It yes describe under WLRC47121310 (VW) 07/01/2012 0710112013 1,000,000
DESCRIPTION OF OPERATIONS below E.L. DISEASE • POLICY LIMIT $
EXCESS LIMIT $1,000,000
A WORKERS COMPENSATION WCUC47121358 (OH only) 07101I2012 0710112013 SIR $1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
CITY OF CLEARWATER
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 WILI BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISiONS.
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Manashi Mukherjee �'�.au.m�ea� �.j,+�-tc.AS�,�t.=-
m 1988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
0004347 SP 0230 •C01-P04349-I
CITY OF CLEARWATER
ATTN: CITY CLERK
PO BOX 4748
CLEARWATER, FL 33758 �