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CERTIFICATE OF LIABILITY INSURANCE (13)A ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM /401) 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 Aon Risk Services Central, Inc. Philadelphia PA Office One Liberty Place 1650 Market Street Suite 1000 Philadelphia PA 19103 USA CONTACT NAME: PHONE (866) 283 -7122 IF' (800) 363 -0105 (NC. No. E:t): (NC. No.): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Cigna Corporation Et Al 900 Cottage Grove Road Bloomfield CT 06002 USA INSURER k. ACE American Insurance Company 22667 INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: :570051560076 REVISION NUMBER: 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 INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF IMM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS GENERAL — LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑ OCCUR EACH OCCURRENCE DAMAGE 10 REN FED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP /OP AGG GEN'L AGGREGATE LIMIT APPLIES PER: POLICY II MGT n LOC AUTOMOBILE — LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS — _ SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY ( Per person) BODILY INJURY (Per accident) (Per OaccidentDAMAGE ) UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE AGGREGATE DEDI RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABIL FY ANY PROPRIETOR / PARTNER / EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) If yes describe under DESCRIPTION OF OPERATIONS below N / A WC STATU- TORY LIMITS 0TH - ER E.L. EACH ACCIDENT E.L. DISEASE -EA EMPLOYEE E.L. DISEASE- POLICY LIMIT A ManageCare Liab M5PG27030543003 Primary Managed Care E&0 SIR applies per policy terms 10/01/2013 & condi 10/01/2014 :ions Aggregate Each Claim $5,000,000 $5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) CERTIFICATE HOLDER CANCELLATION City of Clearwater Attn: City Clerk PO Box 4748 Clearwater FL 33758 -4748 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TIE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH TIE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE c.iKlAlb i % %'eGrIQQG V�iLf�glN (��[�i ✓fIQ Holder Identifier : Certificate No : 570051560076 ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A C ® CERTIFICATE OF LIABILITY INSURANCE DATE(0 //0 JD 3 ) 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 AOn Risk Services Central, Inc. Philadelphia PA Office One Liberty Place 1650 Market Street Suite Philadelphia ph Phila LISA ia PA 19103 CONTACT NAME: PHONE (- (NC. No. Ext): 866) 283 7122 I (NC. No.): (800) 363 -0105 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Ciana Corporation Et Al 900 Cottage Grove Road Bloomfield CT 06002 USA INSURER A: ACE American Insurance Company 22667 INSURER B: INSURER C: EACH OCCURRENCE INSURER D: — INSURER E: DAMAGE 1 0 REN1 ED PREMISES (Ea occurrence) INSURER F: MED EXP (Anyone person) ERTIFICATE NUMBER: 570051560076 REVISION NUMBER: 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 INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP (MM/DD/YYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE — COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑ OCCUR DAMAGE 1 0 REN1 ED PREMISES (Ea occurrence) MED EXP (Anyone person) PERSONAL & ADV INJURY GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER: LOC PRODUCTS - COMP /OP AGG —1 POLICY II JECT n AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) — ANY AUTO BODILY INJURY ( Per person) ALL OWNED AUTOS HIRED AUTOS — _ SCHEDULED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE AGGREGATE DED I (RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A I WORY LIMBS I 10TH E.L. EACH ACCIDENT E.L. DISEASE -EA EMPLOYEE E.L. DISEASE - POLICY LIMIT A Managecare Liab — -� - �SARrappI4.4s MSPG27030543003 Primary Managed Care E&0 per policy terms 10/01/2013 & condi-ions 10/01/2014 Aggregate Each Claim $5,000,000 $5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach' ACORD 101 „AddIBonal Remarks Schedule, If more space is required) CERTIFICATE HOLDER CANCELLATION city of Clearwater Attn: city Clerk PO Box 4748 Clearwater FL 33758 -4748 USA 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 a % G t9/LtdJS G ✓saes Holder Identifier : Certificate No : 570051560076 eh- • ACORD 25 (2010/05) @1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD