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CERTIFICATE OF LIABILITY INSURANCE (6)ACCORD ® CERTIFICATE OF LIABILITY INSURANCE M/DD/YYYY) DATE (M(MM16 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 MARSH USA INC. 540 W. MADISON CHICAGO, IL 60661 Attn: chicago.CertRequest@marsh.com CONTACT NAME' PHONE FAX (A/C. No. Exu: (A/C, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Travelers Property Casualty Company of America 25674 INSURED CorVel Healthcare Corporation Attn: Jay Villeda 2010 Main Street, Suite 600 Irvine, CA 92614 INSURER B : XL Specialty Insurance Company 37885 INSURER C : Illinois Union Insurance Company 27960 INSURER D : The Travelers Indemnity Company 25658 INSURER E : $ 1,000,000 INSURER F : COVERAGES CERTIFICATE NUMBER: CHI -008291771-86 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. 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 INSD SUBR WVD POLICY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY TJGLSA280K5095TIL18 04/30/2018 04/30/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE RTED PREM SESO(Ea occurrence) $ 1,000,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE POLICY OTHER. LIMIT APPLIES PRO JECT X PER: LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED AUTOS NON -OWNED AUTOS ONLY TJCAP280K5102TIL18 04/30/2018 04/30/2019 COMBINacc,dEenDt) SINGLE LIMIT (Ea $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ Comp./Coll. Ded. $ 500 B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE US00067014L118A 04/30/2018 04/30/2019 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 $ DED X RETENTION $10,000 A D WORKERS COMPENSATION AND EMPLOYERS' LIABILITYSTATUTE ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N N / A TC2JUB280K507118 (AOS) TRKUB280K508318 (AZ, MA, NE, WI) 04/30/2018 04/3012018 04/30/2019 04/30/2019 X PER OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L_ . DISEASE - EA EMPLOYEE $ 1,000,000 E L DISEASE - POLICY LIMIT $ 1,000,000 C Managed Healthcare Prof. Liab. MSP G27108647 005 (SIR: $300,000) Retro date: 04-10-1987 10/31/2017 10/31/2018 Per Claim Aggregate 5,000,000 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. CERTIFICATE HOLDER CANCELLATION City of Clearwater Attn: John Marcin 100 S. Myrtle Ave. Clearwater, FL 34616 I 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 .._M r,>,e cvwo►.%- 44AA..te..,•-c-t- ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD