CERTIFICATE OF LIABILITY INSURANCE (27)®
ACS
�— CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
09/26/2019
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.
Phi 1 adel phi a PA Office
One Liberty Place
1650 Market street
Suite 1000
Phi 1 adel phi a PA 19103 USA
CONTACT
PHON:
(NC. NE No. Ext): (866) 283-7122 FAX No ): (800) 363-0105
E-MAIL DRIL
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURED
Cigna corporation Et Al
900 Cottage Grove Road
Bloomfield CT 06002 USA
INSURER A: Lexington Insurance Company
19437
INSURER B:
f'; 7- 4" N. ST
r
INSURER C:
INSURER D:
INSURER E:
INSURER F:
CLAIMS -MADE ❑ OCCUR
COVERAGES
CERTIFICATE NUMBER: 570078495455
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
SUER W
VD
POLICY NUMBER
M/POLICYEFF
IMDD/YYYY)
POLICY EXP
(MM(DDIYYYY)
LIMITS
COMMERCIAL GENERAL LIABILITY
f'; 7- 4" N. ST
r
'r-' '
EACH OCCURRENCE
CLAIMS -MADE ❑ OCCUR
DAMAGE TO RENTED
PREMISES (Ea occurrence)
MED EXP (Any one person)
- -
PERSONAL & ADV INJURY
GEN'L
AGGREGATE LIMITAPPLIES PER:
•
GENERAL AGGREGATE
POLICY ❑ PRO -LOC
JECT
PRODUCTS - COMP/OP AGO
OTHER:
�[F'" ''
AUTOMOBILE LIABILITY
1EGOL✓,li'> .-,j,,
''�j �jLl-!
COMBINED SINGLE LIMIT
(Ea accident)
ANY AUTO
BODILY INJURY ( Per person)
OWNED
—
SCHEDULED
AUTOS
BODILY INJURY (Per accident)
AUTOS ONLY
HIRED AUTOS
ONLY
NON -OWNED
AUTOS ONLY
PROPERTY DAMAGE
(Per accident)
—
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
EXCESS LIAB
CLAIMS -MADE
AGGREGATE
DED RETENTION
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
PER
STATUTE
OTH-
ER
ANY PROPRIETOR / PARTNER / EXECUTIVE
Y/N
N I A
E.L. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
E.L. DISEASE -EA EMPLOYEE
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE -POLICY LIMIT
A
ManageCare Liab
33085874
Managed Care E&0
07/01/2019
07/01/2020
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
Holder Identifier :
Certificate No
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
ACORD 25 (2016/03)
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