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CERTIFICATE OF LIABILITY INSURANCE (19)'°' °® CERTIFICATE OF LIABILITY INSURANCE DAT09/ 6/220115 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 1 adel phi a PA Office One Li be rty Place 1650 Market Street Suite 1000 Phi 1 adel phi a PA 19103 USA CONTACT NAME: INC No. Est): (866) 283 -7122 FAX No.): (800) 363 -0105 E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Ci cina Corporati on Et Al 900 cottage Grove Road Bloomfield CT 06002 USA INSURER A: ACE American Insurance Company 22667 INSURER B: INSURER C: m�, c:Y INSURER D: EACH OCCURRENCE INSURER E: INSURER F: CLAIMS -MADE OCCUR CERTIFICATE NUMBER: 570059359532 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 D/ (MM/DYYYY) POLICYEXP (MM/DD/YYYYI LIMITS COMMERCIAL GENERAL LIABILITY F��t m�, c:Y EACH OCCURRENCE CLAIMS -MADE OCCUR M R DAMAGE TO RETED PREMISES Ea occurrence) St . _P 4 23 C c-il'IC M R CO DS C RECORDS Th p AN 1 MED EXP (Any one person) PERSONAL & ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE PRO - POLICY I I JECT PRODUCTS - COMP /OP AGG OTHER. OTHER: AUTOMOBILE LIABILITY LISISLATIVV SR VCS DEPT D CO aBINEDtSINGLE LIMIT JEa 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 LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE AGGREGATE DED I RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N N I A PER STATUTE OTH- ER ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If describe under E.L. EACH ACCIDENT E.L. DISEASE -EA EMPLOYEE yes, DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT A ManageCare Liab MSPG27030543005 Primary Managed Care E&0 SIR applies per policy terms 10/01/2015 & condi-ions 10/01/2016 Agg - Claims Made $15,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 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 'O7S c`% etlC�G ViGL4C� I��b7E4a J DEL ACORD 25 (2014/01) ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Holder Identifier : Certificate No : 570059 LLi