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CERTIFICATE OF LIABILITY INSURANCE (14)® ACC) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 05/02/2014 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. 1717 Arch Street Philadelphia, PA 19103-2797 Attn: Healthcare .AccountsCSS@marsh.com FAX: 212 - 948 -1307 100607 - PRIM -CRIME -14-15 CONTACT NAME: FAX (NC No. Est): (A/C. No): ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : National Union Fire Insurance Co. of Pittsburgh, Pa 19445 INSURED CIGNA CORPORATION 900 COTTAGE GROVE ROAD BLOOMFIELD, CT 06002 INSURER B INSURER C : INSURER D : $ INSURER E : $ INSURER F : $ • LE- 003404728 -20 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 LTR TYPE OF INSURANCE Am_ INSR SUBR WVD POLICY NUMBER POLICY EFF 1MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ RENTED DAMAGE TO PREMISES (Ea occurrence) $ MED EXP (My one person) $ CLAIMS -MADE OCCUR PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP /OP AGG $ GEN'L AGGREGATE n POLICY LIMIT APPLIES PER: PRO Ti IFCT LOC $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS I' �� .--� , 1 1 _ .. COMBINED SINGLE LIMIT (Ea accident) _.$ $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ PROPERTY e DAMAGE PE) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE ��oo : , ! 6 i' s Y ' " R.,_. l ^, .»r f J LI "' EACH OCCURRENCE $ AGGREGATE $ $ DED RETENT ON $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 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 OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ A CRIME / FIDELITY 063777988 04/30/2014 04/30/2015 LIMIT $5,000,000 DEDUCTIBLE $2,500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CELLATION CITY OF CLEARWATER, FLORIDA ATTN: CITY CLERK PO BOX 4748 CLEARWATER, FL 33758 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 Mukherjee _IvExa.- ,"-sho .....301 t+c I+a e.4 ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORO® AGENCY CUSTOMER ID: 100607 LOC #: Philadelphia ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY Marsh USA Inc. POLICY NUMBER CARRIER NAIC CODE NAMED INSURED CIGNA CORPORATION 900 COTTAGE GROVE ROAD BLOOMFIELD, CT 06002 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance "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 / CRIME CERTIFICATES." ACORD 101 (2008101) 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 0004036 SP 0157 - C01- P04038 -I CITY OF CLEARWATER, FLORIDA ATTN: CITY CLERK PO BOX 4748 CLEARWATER, FL 33758