CERTIFICATE OF LIABILITY INSURANCE (11)CERTIFICATE OF LIABILITY INSURANCE I DA�T�Z1�M�M1DD/YYYY�
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVEIY 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 tertns 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
w�n usa inc.
1717 Arch Street
Ph�adelphia, PA 191032797
Attn: H�Itlicare.AccounLsCSS@m�sh.comlFAX: 212 948-1307
100607-PRIM-CRIME-1 &14
INSURED
CIGNA CORPORATION
900 COTTAGE GROVE ROAD
BLOOMFIELD, CT 06002
A: Na6onal Union Fire Insurance Co. of Pittsburgh, Pa I 19445
COVERAGES CERTIFICATE NUMBER: CLE-003404728-17 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. NOTIMTHSTANDING 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 SHOVIM MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TypE OP INSURANCE AD L SUBR p�uCY NUMBER MM/DDY/YYYY MM/DDlYYYY LIMITS
LTR
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY PREM SES EaEoccu ence $
CLAIMS-MADE � OCCUR MED EXP (My ane person) $ _
PERSONAL 8 ADV INJURY $
GENERALAGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: PROOUCTS - COMP/OP AGG $
-ra -
POLIGY PR� LOC ��� $
AUTOMOBILE LIABIIITY �,,;;�ti..:%---"' ," COMBINED SINGIE LIMIT
Ea accident _
ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED q� �'""v �' r' �� BODILY INJURY (Per accideM) $
AUTOS AUTOS �� i�, c, ' .
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS Per accident .
1 "�>`�i� ,m„`." '.e a,✓bu" .��:�ti.� $
UMBRELLALWB OCCUR ��Q� ��.yy����' ,,�;`, V�v ���{ � EACHOCCURRENCE $
El(CESS UAB CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
WORKERS COMPENSATION V1�C 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 / FIDELfTY 019502894 04/30/2013 04/30/2014 LIMIT $5,000,000
DEDUCTIBLE $2,500,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additlonal Remarks Schedule, if more space is requlred)
CITY OF CLEARWATER, FLORIDA
ATTN: CITY CLERK
PO BOX 4748
CLEARWATER, FL 33758
ACORD 25 (2010I05)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCE4LED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Manashi Mukhery'ee ..,�'�'C+�u.r�sa*-=
� 1988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ACaENCY
Marsh USA Inc.
POLICY NUMBER
CARRIER
AGENCY CUSTOMER ID: 100607
LOC #: Philadelphia
ADDITIONAL REMARKS SCHEDULE Page 2 of 2
NAIC CODE
NAMEDINSUREO
CIGNA CORPORATION
900 COTTAGE GROVE ROAD
BLOOMFIELD, CT 06002
EFFEC7IVE DATE:
ACORD 101 (2008/01) �O 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
0001651 SP 0124 -001-P01651-I
CITY OF CLEARWATER, FLORIDA
ATTN: CITY CLERK
PO BOX 4748
CLEARWATER, FL 33758 �
� �