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CERTIFICATE OF LIABILITY INSURANCE (23)'-----1 ® A' CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) 09/27/2017 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 have ADDITIONAL INSURED provisions or 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. Philadelphia PA Office One Li be rty Place 1650 Market Street suite 1000 Philadelphia PA 19103 USA CONTACT NAME: PHONE (866) 283 -7122 FAX (800) 363 -0105 (A/C. No. Ext): (A/C. No.): E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Cigna Corporation Et Al 900 Cottage Grove Road Bloomfield CT 06002 USA INSURER A: ACE American Insurance Company 22667 INSURER B: - @ •_:: - /,, ` ", - �' 4' INSURER C: INSURER D: INSURER E: INSURER F: DAMAGE TO RENTED PREMISES (Ea ICATE NUMBER: 570068618128 • 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 ADDLSUBR INSD WVD POLICY NUMBER POLICY EFF (MWDDIYYYY) POLICYEXP (MMIDDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY - @ •_:: - /,, ` ", - �' 4' EACH OCCURRENCE CLAIMS -MADE ❑ OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: PRO- GENERAL AGGREGATE POLICY I I JECT I I LOC OTHER: PRODUCTS - COMP /OP AGG AUTOMOBILE LIABILITY `� s - I L',-y ' •' ' ' '.. • COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY ( Per person) OWNED AUTOS ONLY HIRED AUTOS ONLY - SCHEDULED AUTOS NON -OWNED AUTOS ONLY BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE AGGREGATE DED RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N N I A I PEA UTE I '0TH ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under J EACH ACCIDENT E.L. DISEASE -EA EMPLOYEE DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT A Managecare Liab MSPG27030543007 Claims Made SIR applies per policy terms 10/01/2017 & condi -ions 10/01/2018 Agg - Claims Made $15,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I 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 �X 1a a % cJs�it�ttid mete, ��a ACORD 25 (2016/03) ©1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Holder Identifier : 570068618128 Certificate No