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CERTIFICATE OF LIABILITY INSURANCE (15)® ∎4 .4 . tO CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYYY) 07/01/2014 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 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 I (800) 363 -0105 (NC. No. Est): (A/C. No.): E-MAIL DDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Cigna Corporation Et Al 900 Cottage Grove Road Bloomfield CT 06152 USA INSURER A: ACE American Insurance Company 22667 INSURER B: Indemnity Insurance Co of North America 43575 INSURER C: ACE Fire underwriters Insurance Co. 20702 INSURER D: American Guarantee & Liability Ins Co 26247 INSURER E: INSURER F: DAMAGE TO RENTED PREMISES (Ea occurrence) COVERAGES CERTIFICATE NUMBER: 570054426873 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 INSD SUBR W VD ' " - _ POLICY NUMBER ' "` POLICY EFF (tMM /DD/YYYY) POLICY EXP IMM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY HDOG27334106 07/01 /2014 07/01/2015 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $1,000,000 MED EXP (Any one person) $5,000 PERSONAL 8 ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 X PO- POLICY I I JE T LOC OTHER: PRODUCTS - COMP /OP AGG $1,000,000 A AUTOMOBILE LIABILITY ISA H08820958 07/01/2014 07/01/2015 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X — _ ANY AUTO BODILY INJURY ( Per person) ALL OWNED AUTOS HIRED AUTOS — _ SCHEDULED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) Medical Payments Lia $5,000 D X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE AUC967096606 07/01/2014 07/01/2015 EACH OCCURRENCE $25,000,000 AGGREGATE $25,000,000 DED I !RETENTION B A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE FY /�N OFFICER/MEMBER EXCLUDED? I -, J (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WLRC47888724 (AOS) WLRC47888712 (CA, MA) 07/01/2014 07/01/2014 -. 07/01/2015 07/01/2015 X IPER STATUTE 10TH- ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 _E.L. DISEASE- POLICY LIMIT $1,000,000 A Excess WC wCuc47888748 (01-1) SIR applies per policy terms 07/01/2014 & condi-ions 07/01/2015 EL Each Accident EL Disease - Policy EL Disease - Ea Emp $1,000,000 $1,000,000 $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Insured name: CIGNA CORPORATION. 900 COTTAGE GROVE ROAD. CERTIFICATE HOLDER CANCELLATION CITY OF CLEARWATER Attn: CITY CLERK PO Box 4748 CLEARWATER FL 33758 USA Holder Identifier 570054426873 Certificate No 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 ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ACORL3 AGENCY CUSTOMER ID: 10042023 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk Services Central, Inc. NAMED INSURED Cigna Corporation Et Al POLICY NUMBER See Certificate Number: 570054426873 CARRIER See Certificate Number: 570054426873 NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR W VD POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YYYY) POLICY EXPIRATION DATE ( MM/DD/YYYY) LIMITS WORKERS COMPENSATION C N/A SCFC47888736 (WI) 07/01/2014 07/01/2015 A N/A WLRC47888608 (WV) 07/01/2014 07/01/2015 ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved.