CERTIFICATE OF LIABILITY INSURANCE (2)ACORU® CERTIFICATE OF LIABILITY INSURANCE
DATE( 11I10/2015 YY)
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
MARSH USA INC.
540 W. MADISON
CHICAGO, IL 60661
Attn: chicago.CertRequest@marsh.com
CONTACT
NAME:
PHONE aC No):
ADDRESS:
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE a OCCUR
INSURERS AFFORDING COVERAGE
NAIC #
INSURER A: Travelers Property Casualty Company of America
25674
$ 1,000,000
INSURED
CorVel Healthcare Corporation
INSURER B ; XL Specialty Insurance Company
37885
INSURER C : Illinois Union Insurance Company
27960
Attn: Jay Villeda
2010 Main Street, Suite 600
Irvine, CA 92614
INSURER D:
INSURER E:
INSURER F
COVERAGES CFRTIFICOTF NI IMRFR• CHI- nnAn1QR11 -7R DI=11Ietnw uI wcco.z
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
SUBR
POLICY NUMBER
POLICY EFF
MM/DD /YYYY )
POLICY EXP
(MMIDD/YYYYI
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE a OCCUR
TJGLSA280K5095 -15
04/30/2015
04/30 /2016
EACH OCCURRENCE
$ 1,000,000
DAMAGES ( RENTED
PREMISES Ea occurrence)
$ 1,000,000
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000,000
GENT AGGREGATE LIMIT APPLIES PER
POLICY ❑ JECOT- a LOC
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP /OP AGG
$ 2,000,000
$
OTHER:
A
AUTOMOBILE
LIABILITY
TJCAP280K5102 -15
04/30/2015
04/30 /2016
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
X
LY
BODI INJURY (Per person)
$
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
IAUTOS
BODILY INRY
INJURY Per accident
( )
$
X
HIRED AUTOS X NON -OWNED
PROPERTY DAMAGE
Per accident
$
CompJColl. Ded.
$ 500
B
X
UMBRELLA LIAB
X
OCCUR
US00067014LI15A
04/3012015
04/30/2016
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
EXCESS LIAB
CLAIMS -MADE
DED I X I RETENTION $10,000
$
A
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR /PARTNER /EXECUTIVE
OFFICER /MEMBER EXCLUDED?
N / A
TC2JUB28OK5071 -15
TRJU6280K5083 -15
04/30/2015
0413012015
04/30/2016
04/3012016
X PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYE
$ 1,000,000
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
C
Managed Healthcare Prof. Liab.
MSP G27108647 003 (SIR: $300,000)
10/3112015
10/3112016
Per Claim 5,000,000
Retro date: 04-10 -1987
Aggregate 5,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
City of Clearwater is Additional Insured with respect their interest.
v�F%I Irwrl I V nvL_uV_rc GANGtLLA I IUN
City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Attn: John Marcin THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
100 S. Myrtle Ave. ACCORDANCE WITH THE POLICY PROVISIONS.
Clearwater, FL 34616
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Manashi Mukherjee+R t>4, n,a�>ti.: �� ti► ✓<c qs�. i L
C 1988 -2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD