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CERTIFICATE OF LIABILITY INSURANCE�� � .�::��: . � .. . DATE (MM/DD/YYYY) ,4coRC� CERTIFICATE OF LIABILITY INSURANCE o�i3or�o�5 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 TNE 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). PROOUCER CONTACT MARSH USA INC. NAME: 540 W. MADISON PHONE A/C No : CHICAGO, IL 60661 E-MAIL Attn: chicago.CertRequest@marsh.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED CorVel Healthcare Corpaatlon Attn: Jay Villeda 2010 Main Street, Suite 600 Irvine, CA 92614 COVERAGES CERTIFICATE NUMBER: uaeR a: Travelers Property Casualty Canpany of America uReR e:� Specialty Insurance Company uReR c: Illinois Union Insurance Company URER D : URER E : URER F : CHI-004009962-73 REVISION NUMBER:3 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 7ypE OF INSURANCE ADOL SUBR pOLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS LTR A GENERAL LIABILITY TJGLSA280K5095-15 04/30/2015 04/30/2016 EACH OCCURRENCE g 1,000,000 X DAMA E TO RENTED 1,000,000 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE � OCCUR MED EXP (Any one person) $ iO,OOO PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY PR� X LOC $ A AUTOM081LE LIABILITY TJCAP280K5102-15 04130/2015 O4/3OIZOIB COMBINED SINGLE LIMIT 1,000,000 Ea accideni ANY AUTO BODILY INJURY (Per person) $ ALL OWNED X SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident Comp./Coll. Ded. S 50p B X UMBRELLA LIAB X OCCUR US00067014LN5A OM3012015 04/30/2016 EqCH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,OOI1,000 DED X RETENTION $ �0,000 $ ({ WORKERSCOMPENSATION TC2JU8280K5071-15 04130120t5 O4I3O/ZO1B X WCSTATU- OTH- AND EMPLOYERS' LIABILITY A ANYPROPRIETOR/PARTNER/EXECUTIVE Y�N TRJU6280K5083-15 O4I3OIZO�S O4/3O/ZO1B E.L.EACHACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? � N � A (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe under 1,0�,�� DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ C Managed Healthcare Prof. Liab. MSP G27108647 002 (SIR: 300,000) 11/13/2014 10/31/2015 Per Claim 5,000,000 Retro date: 0410-1987 Aggregate 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Altach ACORD 101, Additional Remarks Schedule, If more space Is requiretl) City of Clearwater is Additional Insured with respect their interest. Ciry of Clearwater Attn: John Maran 100 S. MyAle Ave. Clearwater, FL 34616 ACORD 25 (2010/05) CANCELLA 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. IManashi Mukherjee ��+.ura� .�.�,r�.n�,�-ex.. O 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORU® CERTIFICATE OF LIABILITY INSURANCE �, ,�- DATE /2014 /YYYY) 1110612014 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. 540 W. MADISON CHICAGO, IL 60661 Attn: chicago.CertRequest@marsh.com CONTACT NAME: FAX (A/C.NNo. EMI: (A/C. No): E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Travelers Property Casualty Company of America 25674 INSURED CorVel Healthcare Corporation Attn: Dee Bergeon 2010 Main Street, Suite 600 Irvine, CA 92614 INSURER B : XL Specialty Insurance Company 37885 INSURER C : Illinois Union Insurance Co 27960 INSURER D : $ 1,000,000 INSURER E : $ 1,000,000 INSURER F : COVERAGES CERTIFICATE NUMBER: CHI - 004009962 -69 REVISION NUMBER: 3 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 ADDL INSR SUBR VD POLICY POCY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY TJGLSA280K5095 -14 04/30/2014 04/30 /2015 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE 7 POLICY LIMIT APPLIES PRO- JEST X PER: LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X x SCHEDULED AUTOS NON -OWNED AUTOS TJCAP280K5102 -14 04/30/2014 04/30/2015 CO eBBINED SINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ Comp /Coll. Ded. $ 500 B X UMBRELLA LIAB EXCESS UAB X OCCUR CLAIMS -MADE US00067014L114A 04/30/2014 04/30/2015 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED X RETENTION $10,000 $ A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER/EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N N / A TC2JUB28OK5071 -14 TRJUB280K5083 -14 04/30/2014 04/30/2014 04/30 /2015 04 /30/2015 X WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 $ C Managed Healthcare Prof. Liab. MSP G27108647 001 (SIR: $300,000) Retro date: 04-10 -1987 11/15/2013 11/13/2014 Per Claim 5,000,000 Aggregate 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) REC, tIV ED City of Clearwater is Additional Insured with respect their interest. CITY OF C I.. E A R W AT E R NOV 1. 9 2014 RISK MANAGEMENT 9173 CERTIFICATE HOLDER CANCELLATION City of Clearwater Attn: John Martin 100 S. Myrtle Ave. Clearwater, FL 34616 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 - 3..amu.no4.+ 4+1.44 fc.r,.a:we,a- ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AC•RD® CERTIFICATE OF LIABILITY INSURANCE `.... - -- DATE(MM/DD/YYYY) 11/14/2014 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 bR 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. 540 W. MADISON CHICAGO, IL 60661 Attn: chicago.CertRequest@marsh.com CONTACT NAME: PHONE FAX Ext): (A/C, No): E-MAIL CNo. ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Travelers Property Casualty Company of America 25674 INSURED CorVel Healthcare Corporation Attu: Jay Villeda 2010 Main Street, Suite 600 Irvine, CA 92614 XL Specialty Insurance Company INSURER B : p h) p an y 37885 INSURER c : Illinois Union Insurance Co 27960 INSURER D $ 1,000,000 INSURER E : $ 1,000,000 INSURER F : COVERAGES CERTIFICATE NUMBER: CHI - 004009962 -71 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 ADDL INSR SUBR WVD POLICY NUMBER POUCY EFF (MM /DDIYYYY) POUCY EXP (MMIDD/YYYY) LIMITS A GENERAL X UABILITY COMMERCIAL GENERAL LIABILITY TJGLSA280K5095 -14 04/30/2014 04/30 /2015 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE 7 POLICY LIMIT APPLIES PRO- JFCT X PER: LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ A AUTOMOBILE X UABILTY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X X SCHEDULED AUTOS NON -OWNED AUTOS TJCAP280K5102 -14 04/30/2014 04/30/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ CompJColl. Ded. $ 500 B X UMBRELLA LIAB EXCESS UAB X OCCUR CLAIMS -MADE US00067014L114A 04/30/2014 04/30/2015 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED X RETENT ON $10'000 $ A A WORKERS COMPENSATION AND EMPLOYERS' UABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N N / A TC2JUB280K5071 -14 TRJUB280K5083 -14 04/30/2014 04/30/2014 04/30 /2015 04/30/2015 X WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 $ C Managed Healthcare Prof. Liab. MSP G27108647 002 (SIR: 300,000) Retro date: 04-10 -1987 11/13/2014 10/31/2015 Per Claim 5,000,000 Aggregate 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) City of Clearwater is Additional Insured with respect their interest. CERTIFICATE HOLDER CANCELLATION City of Clearwater Attn: John Martin 100 S. Myrtle Ave. Clearwater, FL 34616 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 - C oes* » --31040.444-1, ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A °® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 04/30/2013 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. 540 W. MADISON CHICAGO, IL 60661 Attn: chicago.CertRequest @marsh.com CONTACT NAME: PHONE FAX (A/C. No. Ext): (A/C, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Travelers Property Casualty Company Of America 25674 INSURED CorVel Healthcare Corporation Attn: n: Abigail Keenan 2010 Main Street, Suite 600 Irvine, CA 92614 INSURER B : St. Paul Fire & Marine Ins Co 24767 INSURER C : Insurance Company Homeland I C n Of New York 34452 INSURER D : $ 1,000,000 INSURER E : $ 1,000,000 INSURER F : COVERAGES CERTIFICATE NUMBER: CHI - 004009962 -61 • 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 ADDL INSR_WVD SUBR POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MWDD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY TJGLSA280K509513 04/30/2013 04/30/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE POLICY LIMIT APPLIES PRO X PER: PRODUCTS - COMP /OP AGG $ 2,000,000 A AUTOMOBILE _ X _ LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X _ X _AUTOS SCHEDULED AUTOS NON -OWNED TJCAP280K510213 04/30/2013 04/30/2014 COMBINED SINGLE LIMIT (Ea accident) $ i,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ Comp. /Coll. Ded. $ 500 B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE ZUP10P8170613NF 04/30/2013 04/30/2014 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED X RETENT ON $10,000 $ A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/ N N N / A TC2JUB280K507113 TRJUB280K508313 04/30/2013 04/30/2013 04/30/2014 04/30/2014 X 1 WC STATU- 0TH - TORY LIMITS I ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 $ C Managed Healthcare Prof. Liab. MCR- 6000 -12 (SIR $300,000) Retro date: 04 -10 -1987 10/31/2012 10/31/2013 Per Claim 5,000,000 Aggregate 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Clearwater is Additional Insured with respect their interest. CERTIFICATE HOLDER CANCELLATION City of Clearwater Attn: John Marcin 100 S. Myrtle Ave. Clearwater, FL 34616 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 ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AC•RO® CERTIFICATE OF LIABILITY INSURANCE `„� -- DATE(MM/DD/YYYY) 10/3112012 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. 540 W. MADISON CHICAGO, IL 60661 Attn: chicago.CeIRequest@marsh.com 401944-Std- Prof -12 -13 CONTACT NAME' PHONE FAX (A/C. No. Est): (A/C, No): E-MAIL ss: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Travelers Property Casualty Company Of America 25674 INSURED CorVel Healthcare Corporation Attn: Jeanette Mungcal 2010 Main Street, Suite 600 Irvine, CA 92614 INSURER B : St. Paul Fire & Marine Ins Co 24767 an Homeland Insurance Company Of New York INSURER C : P Y 34452 INSURER D : $ 1,000,000 INSURER E : 1,000,000 $ INSURER F : COVERAGES CERTIFICATE NUMBER: CHI - 004009962 -56 REVISION NUMBER: 3 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 ADDL INSR SUBR W VD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YY) YY LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY TJGLSA280K5095TIL12 04 /30/2012 04/30/2013 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) 1,000,000 $ CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES n POLICY n !7119-1- - JEC X PER LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X X SCHEDULED AUTOS NON -OWNED AUTOS TJCAP280K5102TIL12 04/30/2012 04/30 /2013 COMBINED SINGLE LIMIT (Ea accident) 1,000,000 BODILY INJURY (Per person) _$ $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ Comp. /Coll. Ded. $ 500 B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE ZUP- 10P81706 -12 -NF 04/30/2012 04/30 /2013 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 $ DED X RETENT ON $10'000 A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N N / A TC2JUB280K507112 TRJUB280K508312 04/30/2012 04/30/2012 04/30/2013 04/30 /2013 X WC STATU- TORY I IMITS OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 $ C Managed Healthcare Prof. Jab. MCR- 6000 -12 (SIR $300,000) Retro date: 04-10 -1987 10/31/2012 10/31/2013 Per Claim 5,000,000 Aggregate 5,000,000 RECEIVED DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CITY OF CLEARWATER City of Clearwater is Additional Insured with respect their interest. NOV 072012 RISK MANAGEMENT 9173 CANCELLATION City of Clearwater Attn: John Marcin 100 S. Myrtle Ave. Clearwater, FL 34616 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 tin.lo ti ac-nt -t.t. ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORD CERTIFICATE OF LIABILITY INSURANCE � -- DATE /YYYY) 04/27/2012 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. 540 W. MADISON CHICAGO, IL 60661 RECEIVED Attn: chicago.CertRequest @marsh.com CITY OF CLEARWATER 401944 -Std- Prof -12 -13 MAY 01 CONTACT NAME: PHONE FAX (A/C. No. Ext): (A/c, No): E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Travelers Property Casualty Company Of America 25674 INSURED 2012 CorVel Healthcare Corporation Attn: Jeanette Mungcal RISK MANAGEMENT 2010 Main Street, Suite 600 9173 Irvine, CA 92614 INSURER B : St. Paul Fire & Marine Ins Co 24767 INSURER C : Employers Fire Insurance Company 20648 INSURER D $ 1,000,000 INSURER E : $ 1,000,000 INSURER F : COVERAGES CERTIFICATE NUMBER: CHI-004009962-54 REVISION NUMBER: 3 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 AWL INSR SUER WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MWDD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY TJGLSA280K5095TIL12 04/30/2012 04/30/2013 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 GE 'L AGGREGATE POLICY LIMIT APPLIES PRO- X PER: LOC $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X X SCHEDULED AUTOS NON -OWNED AUTOS TJCAP280K5102TIL12 04/30/2012 04/30/2013 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ Comp. /Coll. Ded. $ 500 B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE ZUP- 10P81706 -12 -NF 04/30/2012 04/30/2013 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 $ DED X RETENT ON $10,000 A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE 1121 N OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A TC2JUB280K507112 TRJUB280K508312 04/30/2012 04/30/2012 04/30/2013 04/30/2013 X WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 $ C Managed Healthcare Prof. Liab. $200,000 SIR MCP - 5260 -11 Retro date: 04 -10 -1987 10/31/2011 10/31/2012 Per Claim 5,000,000 Aggregate 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Clearwater is Additional Insured with respect their interest. CERTIFICATE HOLDER CANCELLATION City of Clearwater Attn: John Marcin 100 S. Myrtle Ave. Clearwater, FL 34616 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 —M,aura a+,1 44M,te -- e,- ACORD 25 (2010/05) ®1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AR °® CERTIFICATE OF LIABILITY INSURANCE DATE /2011 /YYYY) 11 /07/2011 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. 500 WEST MONROE STREET CHICAGO, IL 60661 Attn: Chicago.CertRequest@Marsh.com; Fax: 212- 948 -0770 RECEIVED CITY OF CLEARWATER 401944-HC- wPROF -11 -12 CONTACT NAME: PHONE FAX (A/C, No. Ext): (A/C, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Travelers Property Casualty Company Of America 25674 INSURED r t S CorVel Healthcare Corporation NOV �td i Attn: Jeanette Mungcal 2010 Main Street, Suite 600 RISK MANAGEMENT Irvine, CA 92614 9173 INSURER B St. Paul Fire & Marine Ins Co 24767 INSURER c : Employers Fire Insurance Company 20648 INSURER D : TJGLSA280K5095TIL11 INSURER E : 04/30 /2012 INSURER F : $ COVERAGES CERTIFICATE NUMBER: CHI - 004009962 -51 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/VYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR TJGLSA280K5095TIL11 04/30/2011 04/30 /2012 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000 CLAIMS -MADE X MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT —1 APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY PRO- X LOC A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS -OWNED TJCAP280K5102TIL11 04/30/2011 04/30 /2012 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ X SCHEDULED AUTOS BODILY INJURY (Per accident) $ X _ x NON PROPERTY DAMAGE (Per accident) $ _AUTOS COMP /COLLISION DED. $ 500 B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE QK01202786 04/30/2011 04/30/2012 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED X RETENT ON $10,000 $ A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS Y / N N / A TC2JUB280K507111 TRJUB280K508311 04/30/2011 04/30/2011 04/30 /2012 04/30/2012 X WC STATU- OTH- TORY I IMITS ER E.L. EACH ACCIDENT $ 1,000,000- N E.L. DISEASE - EA EMPLOYEE $ 1,000,000 below E.L. DISEASE - POLICY LIMIT $ 1,000,000 C MANAGED HEALTHCARE PROF LIAB $260,000 SIR MCP - 5260 -11 RETRO DATE: 04 -10 -1987 10/31/2011 10/31/2012 PER CLAIM AGGREGATE 5,000,000 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Clearwater is Additional Insured with respect their interest. CERTIFICATE HOLDER CANCELLATION City of Clearwater Attn: John Marcn 100 S. Myrtle Ave. Clearwater, FL 34616 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 _S•ta' .9.40,.: ,a -Lehtn -ae- ACORD 25 (2010/05) m 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD