CERTIFICATE OF LIABILITY INSURANCE (5)ACORG��
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CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
04/2812017
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 endorsementlsl.
PRODUCER
MARSH USA INC.
540 W. MADISON
CHICAGO, IL 60661
Attn: chicago.CertRequest@marsh.can
INSURED
CorVel Healthcare Corpora6on
Attn: Jay Villeda
2010 Main Street, Suite 600
Irvine, CA 92614
INSURER�S) AFFORDING COVERAGE
Travelers Property Casualty Company of America
XL Specialry Insurance Company
Illinois Union Insurance Company
NAIC #
COVERAGES CERTIFICATE NUMBER: CHI-006039811-82 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. NOTIMTHSTANDING 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 TypE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP
LTR POLICY NUMBER MM/DDNYYY MM/DD/YYYY LIMITS
A X COMMERCIAL GENERAL LIABILITY TJGLSA280K5095-17 04/3012017 04/30/2018 EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE � OCCUR DAMAGE TO RENTED
PREMISES Eaoccurrence $ 1,�0�,0��
MED EXP (Any one person) $ 10,000
PERSONAL & ADV INJURY $ 1,000,000
C�EN'L AGGREGATE LIMIT APPLIES PER: GENER,4L AGGREGATE $ Z,OOO,OOO
POLICY � PR� � LOC PRODUCTS - COMP/OP AGG $ 2,000,000
JECT
OTHER: $
A AUTOMOBILE LIABILITY TJCAP280K5102-17 04/3O/2017 04/3O/2018 COMBINED SINGLE LIMIT $ 1�OOC,000
Ea accident
X ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS
X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $
AUTOS Per accident
Comp./Coll. Ded. $ 500
B X UMBRELLA LIAB X OCCUR US00067014LI17A 04/30I2017 04/30I2018 EACH OCCURRENCE $ 1,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000
DED X RETENTION $10 000 $
A WORKERSCOMPENSATION TC2JUB280K5071-17(AOS) O4/$O/ZOi7 O4I3O/ZOIE X STATUTE �ERH
AND EMPLOYERS' LIABILITY
A ANY PROPRIETOR/PARTNER/EXECUTIVE Y� N TRKU8280K5083-17 (AZ, MA, NE, WI� 04/3012017 O4/3OIZOIE E.L. EACH ACCIDENT $ 'I,OOO,OOO
OFFICER/MEMBER EXCLUDED? � N � A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ 1,000,000
If yes, describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
C Managed Healthcare Prof. Liab. MSP G27108647 004 (SIR: $300,000) 10/31/2016 10131/2017 Per Claim 5,000,000
ReVo date: 0410-1987 Aggregate 5,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 107, Addkfonal Remarka Schedule, may be altached ff more space Is requlred)
City of Clearwater is Additional Insured with respect their interest.
Ciry of Clearwater
Attn: John Marcin
100 S. Myrfle Ave.
Clearwater, Fl 34616
ACORD 25 (2014/01)
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 .,�t„a�,.+.o�ea�.: �'�p4,�,�.,tcu�.e.c.
O 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD