CERTIFICATE OF LIABILITY INSURANCE (16)A R° CERTIFICATE OF LIABILITY INSURANCE
I DAT09/09/20114
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
HOLDER. THIS
BY THE POLICIES
AUTHORIZED
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
(A/C. No. Ext): FAX No.): (800) 363 -0105
E -MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURED
Cigna Corporation Et Al
900 Cottage Grove Road
Bloomfield CT 06002 USA
INSURER A: ACE American Insurance Company
22667
INSURER B:
14
INSURER C:
EACH OCCURRENCE
INSURER D:
INSURER E:
CLAIMS -MADE ❑ OCCUR
INSURER F:
CERTIFICATE NUMBER: 57
•
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
WVD
POLICY NUMBER
POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM /DDIYYYY)
LIMITS
COMMERCIAL GENERAL LIABILITY
RECEIVED
SEP 15 2t
14
EACH OCCURRENCE
CLAIMS -MADE ❑ OCCUR
DAMAGE TO RENTED
MEDMEXPS(Any oneuperson)
PERSONAL & ADV INJURY
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
POLICY JET LOC
OTHER:
PRODUCTS - COMP /OP AGG
AUTOMOBILE LIABILITY
/� Q� -/�
OFFICIAL RECORDS
LEas1An1/E SRVCS
AND
AND
DEPT
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 LAB
EXCESS LIAR
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
AGGREGATE
DED I 'RETENTION
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY Y I N
ANY PROPRIETOR / PARTNER / EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑
N / A
I PER STATUTE
I0TH -
ER
E.L. EACH ACCIDENT
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE -EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
$15,000,000
A
ManageCare Liab
MSPG27030543004
Primary Managed Care E&O
SIR applies per policy terns
10/01/201410/01
& conditions
/2015
Aggregate
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
1.
I
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
c X�O�B M b/G64CLm0 �{0,SRA.e. ne,
Holder Identifier :
Certificate No : 570055083297
ACORD 25 (2014/01)
01988 -2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD