Loading...
Certificates of Insurance ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDIYY) 1/7/00 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY HEAL THCARE INSURANCE SERVICES, INC. AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 820 GESSNER, SUITE 1000 CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE HOUSTON, TEXAS 77024 AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED INSURER A: WESTERN INDEMNITY INSURANCE COMPANY PHYSICIAN RESOURCES, INC. INSURER B: A MEMBER OF AMBULATORY CARE EMERGENCY INSURER C: PURCHASING GROUP,INC. INSURER D: 10 HIGH POINT ROAD TEVERNIER, FL 33070 INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ~~R TYPE OF INSURANCE POLICY NUMBER P~,i" :~~TIVE ENERAL LIABILITY EACH OCCURRENCE $ $ $ $ $ $ LIMITS OMMERCIAL GENERAL LIABLlTY LAIMS MADE QcCUR FIRE DAMAGE (Anyone "Ill) MED EXP (Any ono po",,") PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COM PlOP AGG AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS c,y OMBINED SINGLE LIMIT S Ea accident) ODIL Y INJURY $ Per person) ODIL Y INJURY $ Per accident) PROPERTY DAMAGE $ Per accident) UTO ONLY - EA ACCIDENT S OTHER THAN EAAC S AUTO ONLY: AG S oc nUE_ ,'/''\:\TR: DEDUCTIBLE RETENTION $ ORKERS COMPENSATION AND MPLOYERS' LIABILITY $ $ $ $ $ OTH- ER $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ OTHER A PROFESSIONAL L1ABILlTY- CLAIMS MADE WPLP36203S00 01/01/00 01/01/01 $1.000,000 PER LOSS EVENT $ 3,000,000 POLICY AGGREGATE DESCRlPll0N OF OPERAll0NSlLOCAll0NSNEHICLESlEXCLUSlONS ADDED BY ENDORESEMENTISPECIAL PROVISIONS COVERED PERSON: SANDRA SCHWEMMER, D.O. FOR ACTS PERFORMED ON BEHALF OF MONROE COUNTY EMS. RETROACTIVE DATE: 01/01/99 DATE d CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPlRAll0N DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOllCE TO THE CERllFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLlGAll0N OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHOR~DREPRESENTAnvE CERTIFICATE HOLDER ADDITIONAL INSURED; INSURER LETTER: MONROE COUNTY EMS 490 63RD ST. OCEAN, STE. 170 MARATHON, FL 33050 INITIAL A.U~ @ACORD CORPORATION 1988 ACORD 25-5 (7/97) 05/06/02 PRODUCER Aon Risk Services, Inc of Florida 7650 West Courtney Campbell Cswy Suite 800 Tampa FL 33617 USA THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMA TION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICA TE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PHONE- (813) 636-3525 INSURED Sandra Schwemmer 10 High Point Road Tavernier FL 33070 USA FAX- INSURERS AFFORDING COVERAGE INSURER A: INSURER B: TIG Insurance Company INSURER C. INSURER D: INSURER E: TIlE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATID, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECf 1D WHICH THI S CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN I S SUBJECT TO ALL THE TERMS, EXCLUSIONS AN D CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR l'YPE OF INSURANCE POLICYNUMBER POLICYEFFECllVE POLICYEXPIRA1l0N LTR DATE(MM\DD\YY) DATE(MMlDD\YY) LIMITS A G};NERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMSMADE0 OCCUR HCF39250894 General and Professional Liabi 1/1/2002 1/1/2003 EACH OCCURRENCE $1,000,000 FIRE DAMAGE(Any one fire) MED EXP (Anyone person) PERSONAL & ADV INJURY GENERAL AGGREGATE $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: D PRO- D POLICY JECT LOC PRODUCTS - COMP/OP AGG AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS COMB! NED SINGLE LIMI l' (Ea aa:i dent) NON OWNED AUTOS APPRO BY DATE WAIVER BODILY INIURY (Per persm) SCHEDULED AUTOS lURED AUTOS BODILY INJURY (per accident) PROPERTY DAMAGE (per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ANY AUTO OTHER THAN AurO ONLY: EA ACC AGG EXCESS LlABlLIl'Y OCCUR 0 CLAIMS MADE EACH OCCURRENCE AGGREGATE DEDUCTIBLE RETENTION WORKERS COMPENSATION AND EMPLOYERS' IJABlUrV E.L. DISEASE-POLICY LIMIT E.L. DISEASE-EA EMPLOYEE A OTHER HCF39250894 General and Professional Liabi 1/1/2002 1/1/2003 Per Claim $1,000,000 $3,000,000 Annual Aggregate ProfLiabilitv DESCRIPTION OF OPERATIONSILOCATIONSNEIIICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Professional Liability Retro Date: January 31, 2001 Monroe County Board of County Commissioners 5100 College Road Key West FL 33040 USA SHOUW A NY OF 1lI EABOVE DESCRI IlED POLICIES IlE CA NCELLED BEFORE THE EXPIRA TION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRlrrEN NOTICE TO THE CERTIFICATE IIOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ~"~'~:s.lr-S;:'~ Certificate No : 570002729258 Holder Identifier: CERTIFICATE OF COVERAGE REC.E T U3 2 6 201 Certificate Holder Administrator Issue Date 8/25/11 Professional Emergency Services Inc Florida League of Cities, Inc. 10 High Point Rd Department of Insurance and Financial Services P.O. Box 530065 P.O. Box 379 Orlando, Florida 32853 -0065 Tavernier, FL 33070 COVERAGES THIS IS TO CERTIFY THAT THE AGREEMENT BELOW HAS BEEN ISSUED TO THE DESIGNATED MEMBER FOR THE COVERAGE 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 COVERAGE AFFORDED BY THE AGREEMENT DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH AGREEMENT COVERAGE PROVIDED BY: FLORIDA MUNICIPAL INSURANCE TRUST AGREEMENT NUMBER: FMIT 0386 I COVERAGE PERIOD: FROM 10 /1 /10 COVERAGE PERIOD: TO 10/1/11 12:01 AM STANDARD TIME TYPE OF COVERAGE - LIABILITY TYPE OF COVERAGE - PROPERTY General Liability ❑ Buildings ❑ Miscellaneous ® Comprehensive General Liability, Bodily Injury, Property Damage and El BaSIC Form ❑ Inland Marine Personal Injury ❑ Special Form ❑ Electronic Data Processing ® Errors and Omissions Liability ❑ Personal Property ❑ Bond © Supplemental Employment Practice ❑ Basic Form ® Employee Benefits Program Administration Liability ❑ Special Form ® Medical Attendants' /Medical Directors' Malpractice Liability ❑ Agreed Amount ® Broad Form Property Damage ❑ Deductible N/A ❑ Law Enforcement Liability ❑ Coinsurance N/A © Underground, Explosion & Collapse Hazard odicat ❑ Blanket Limits of Liability ❑ Specific * Combined Single Limit ❑ Replacement Cost Deductible N/A ❑ Actual Cash Value Automobile Liability Limits of Liability on File with Administrator ❑ All owned Autos (Private Passenger) TYPE OF COVERAGE - WORKERS' COMPENSATION ❑ All owned Autos (Other than Private Passenger) ❑ ❑ Statutory Workers' Compensation Hired Autos ❑ Employers Liability $1,000,000 Each Accident ❑ Non -Owned Autos $1,000,000 By Disease $1,000,000 Aggregate By Disease Limits of Liability ❑ Deductible N/A ❑ SIR Deductible N/A Automobile /Equipment - Deductible ❑ Physical Damage NA - Comprehensive - Auto NA - Collision - Auto NA - Miscellaneous Equipment Other The limit of liability is $5,000,000 (combined single limit) bodily injury and /or property damage each occurrence in excess of a self- insured retention of $100,000. This limit is solely for any liability resulting from entry of a claims bill pursuant to Section 768.28 (5) Florida Statutes or liability/settlement for which no claims bill has been filed or liability imposed pursuant to Federal Law or actions outside the State of Florida. Description of Operations /Locations /Vehicles /Special Items RE: EMS Oversight/Medical Direction THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE AGREEMENT ABOVE. Designated Member Cancellations SHOULD ANY PART OF THE ABOVE DESCRIBED AGREEMENT BE CANCELED BEFORE THE Monroe County Board of County Commissioners EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 45 DAYS 1100 Simonton Street Room 2 -268 WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED ABOVE, BUT FAILURE TO MAIL i SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE Key West FL 33040 PROGRAM, ITS AGENTS OR REPRESENATIVES. AUTHORIZED REPRESENATIVE FMIT -CERT (4/2010) THIS ENDORSEMENT CHANGES THE AGREEMENT. PLEASE READ IT CAREFULLY MEDICAL ATTENDANTS'AVEDICAL DIRECTORS' M4LPRACTICE LIABILITY ENDORSEMENT The Coverage Agreement is amended to include the following additional coverage: A. It is agreed that the Trust will pay on behalf of the member all sums which the member becomes legally obligated to pay as damages because of injury 113 any person arising out of the rendering or failure to render, during the period of this Agreement professional services by one of the designated member's Mbdical Attendants and IVbdical Director designated pursuant to Section 401.26E Florida Statutes. The Trust shall have the right and duty to defend any suit against the member seeking such damages, even if any of the allegations of the suit are groundless, false or fraudulent and may make such investigation and such settlement of any daim or suit as it deems expedient but the Trust shall not be obligated to pay any claim or any judgment or to defend any suit after the applicable limitofthe Trusts liability has been exhausted by paymentofjudgments or settlements. 0. EXCLUSIONS This coverage does notapply to: A. Any dishonest fraudulent criminal or malicious act or omissions of the member, any partner or employee, any intentional misconduct or intentional act B. Liability of the designated member as an employer of others or as the proprietor, superintendent or executive officer of any hospital, sanitarium, clinic with bed and board facilities, or other business enterprise; C. To professional services rendered by physicians and,6r nurses; however, this exdusion does not apply to a IVbdical Director designated pursuant to Section 401.26E Florida Statutes, when said Director is acting within the scope and in furtherance of the duties of the M dical Director as outlined in Section 401.26E Florida Statutes. D. To any Bodily Iryury Liability, Property Damage Liability, Personal Injury Liability, Advertising Injury Liability, Products Liability and Completed Operations Hazard arising directly or indirectly out of a. Any actual or alleged failure, malfunction or inadequacy due to the inability to correctly recognize, process, distinguish, interpret or accept the year 2anand beyond by: (1) Any of the following, whether belonging to any insured or to others: (a) Computer application software; (b) Computer networks; (c) Mcroprocessors (computer chips) not part of any computer system; (d) Computer operating systems and related software; (e) Computer hardware, including microprocessors; or (f) Any other computerized or electronic equipment or components; or (Z1 Any other products, and any services, data or functions that directly or indirectly use or rely upon, in any manner, any of the items listed in the preceding paragraph. b. Any advice, consultation, design, evaluation, inspection, installation, maintenance, repair, replacement or supervision provided or done by you or for you to determine, rectify or test for, any potential or actual problems described in paragraph a. above. FMTM410J7 Page 1of1