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CERTIFICATE OF LIABILITY INSURANCE (18)ACORO® �— CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDNYYY) 06/24/2015 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. Phi l adel Philadelphia PA Office One Liberty Place 1650 Market Street suite 1000 Philadelphia PA 19103 USA CONTACT NAME: CNN(No. Ext): (866) 283 -7122 FAX (800) 363 -0105 (NC. No.): 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: ACE Fire Underwriters Insurance Co. 20702 INSURER C: Indemnity Insurance Co of North America 43575 INSURER D: Agri General Insurance Company 42757 INSURER E: American Guarantee & Liability Ins CO 26247 INSURER F: OCCUR NUMBER: 570058220355 REVI 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-if/MY HAVE i3EEN REDUCED BY PAID CLAIMS. Limits shown are as requested INSR LTR TYPE OF INSURANCE ADDL INSD SUBR AND POLICY..NUMBER.' POLIC Y EFF DD POLICY EXP MMIDD/YYYy) LIMITS A X COMMERCIAL GENERAL LIABILITY HDOG27392921 07/01/201 1/2016 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 & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $3,000,000 PRO- POLICY JECT ILOC OTHER: OTHER: PRODUCTS - COMP /OPAGG $1,000,000 A AUTOMOBILE LIABILITY ISA H08856710 07/01/2015 07/01/2016 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 E X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE AUC967096607 07/01/2015 07/01/2016 EACH OCCURRENCE - $25,000,000 AGGREGATE $25,000,000 DED I !RETENTION C A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N N I A WLRC48149339 (A05) WLRC48149327 (CA , MA) 07/01/2015 07/01/2015 07/01/2016 07/01/2016 X PER I STATUTE OTH- ER ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under N E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 A Excess WC WCUC48149352 (OH) SIR applies per policy terms 07/01/2015 & condi -ions 07/01/2016 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 ACORD 25 (2014/01) ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Holder Identifier : N N co O N- u-) Certificate No SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CITY OF CLEARWATER Attn: CITY CLERK PO Box 4748 CLEARWATER FL 33758 USA EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Sjr�f/cpc�JJ/ SZe.egk ACORD 25 (2014/01) ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Holder Identifier : N N co O N- u-) Certificate No AGENCY CUSTOMER ID: 10042023 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk services Central, Inc. NAMED INSURED 1 Cigna Corporation Et Al POLICY NUMBER See Certificate Number: 570058220355 CARRIER See Certificate Number: 570058220355 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 INSR SUBR wVD POLICY NUMBER POLICY EFFECTIVE DATE ( MM/DD/YYYY) POLICY EXPIRATION DATE (MM/DD/YYYY) LIMITS WORKERS COMPENSATION B N/A SCFC48149340 (WI) 07/01/2015 07/01/2016 A N/A WLRC48150652 workers comp (MI) 07/01/2015 07/01/2016 A N/A WLR 048150664 workers comp (NY) 07/01/2015 07/01/2016 A N/A WLR 048150640 Workers Comp (KS) 07/01/2015 07/01/2016 D N/A WLRC48149364 Workers Comp (TN) 07/01/2015 07/01/2016 ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved.