COI Expires 09/27/2012 CERTIFICATE OF INSURANCE
NAMED INSURED cafe is issued as a matter of information only and confers no rights upon the
RECEIVED certificat holder. This certificate does not amend, extend or alter the coverage afforded by
CONSTELLATION SOFTWARE INC. and the polio s below.
TRAPEZE SOFTWARE GROUP INC. INSURANCE COMPANIES AFFORDING COVERAGE
8360 EAST VIA DE VENTURA, #L -200 COMPAN
SCOTTSDALE, AZ 85258 U.S.A. ?''. A Zu ch Insurance Company Ltd. (AM Best rating A)
CERTIFICATE HOLDER OCT 1 1 COMP
B Li rty Mutual Fire Insurance Company (AM Best rating A)
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS COMPAN
1100 SIMONTON STREET MONROE COUNTY C
KEY WEST, FL 33040
RISK MANAGEMENT COMPAN
COMPANY
E Zurich American Insurance Company
COVERAGES
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 ARE IN U.S. DOLLARS UNLESS INDICATED OTHERWISE.
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF INSURANCE CO POLICY NUMBER POLICY POLICY LIMITS OF LIABILITY
LTR EFFECTIVE DATE EXPIRATION DATE
(YYYY /MM /DD) (YYYY /MM /DD)
COMMERCIAL GENERAL LIABILITY $1,000,000 EACH OCCURRENCE
OCCURRENCE BASIS E GL08249874 -00 2011/09/27 2012/09/27
INCLUDING: $1 000 GENERAL AGGREGATE
PRODUCTS AND COMPLETED OPERATIONS
CROSS LIABILITY / SEVERABILITY OF INTERESTS / BLANKET CONTRACTUAL LIABILITY $1 ,000 PRODUCTS - COMPLETED
OPERATIONS AGGREGATE
PERSONAL INJURY $1,000.000 LIMIT, ADVERTISING LIABILITY 51,000,000 LIMIT
TENANT'S LEGAL LIABILITY 51,000,000 LIMIT, MEDICAL EXPENSES 525,000 LIMIT
WAIVER OF SUBROGATION WHERE REQUIRED BY WRITTEN CONTRACT
ADDITIONAL INSURED: MONROE COUNTY BOARD OF COUNTY COMMISSIONERS , but only with respect to liability arising out of the operations of the Named Insured.
Such insurance as is afforded by the Commercial General Liability coverage on this policy will be considered as primary insurance, not contributory and not excess of any other insurance.
NON -OWNED & HIRED AUTOMOBILE
$1 EACH OCCURRENCE
LIABILITY A 883 9016 2011/09/27 • 12/09/ r 1 C
UMBRELLA LIABILITY Not Applicable - _ - - . 1 I�
Not Applicable 6 i\ -t
•
NOT APPLICABLE
PROFESSIONAL LIABILITY AND IPR0435933200 2011/09/27 2012/09/27
$5,000,000 PER CLAIM & IN THE AGGREGATE
TECHNOLOGY ERRORS & OMISSIONS E
CLAIMS MADE BASIS $ 500,000 DEDUCTIBLE
Not Applicable
Not Applicable
WORKERS COMPENSATION & EMPLOYERS E.L.'
UABIUTY -EACH ACCIDENT
WC- STATUTORY UMITS B WC2 -B71- 170802 -010 2011/09/27 2012/09/27 $ 1,000,000 -EACH DISEASE/ EMPLOYEE
INCLUDING WAIVER OF SUBROGATION WHERE - DISEASE POLICY LIMIT
REQUIRED BY WRITTEN CONTRACT
DESCRIPTION OF OPERATIONS / LOCATIONS / SPECIAL PROVISIONS: RE SOFTWARE LICENSE AGREEMENT
BROKER CANCELLATION
The CG&B Group Inc. Should any of the above described policies be cancelled before the expiration date thereof, the issuing
120 South Town Centre Blvd. company wit endeavour to mail 30 days written notice to the certificate holder named above. Failure to
Markham, ON L6G 1 C3 mail such notice shall impose no obligation or liability of any kind upon the company, its agents or
representatives.
SIGNATURE OF AUTHORIZED REPRESENTATIVE PRINT NAME DATE (YYYY /MM /DD)
BRENDA POWRIE 2011/09/16
KR 9/29/11 11:51 AM R3
C' ( < =-k Or!9r��/
THIRD AMENDMENT
TO
SELF - INSURED WELFARE BENEFIT PLAN
ADMINISTRATIVE SERVICE AGREEMENT
THIS THIRD AMENDMENT TO ADMINISTRATIVE SERVICE AGREEMENT
( "Amendment "), made and entered into this 19th day of October, 2011 by and between Monroe County
(hereinafter called "Employer ") and WELLS FARGO THIRD PARTY ADMINISTRATORS of Charleston,
West Virginia, (hereinafter called "Wells Fargo Third Party Administrators ");
WITNESSETij
WHEREAS, the Employer presently receives third party administration (TPA) services from Wells
Fargo Third Party Administrators for certain of Employer's employee benefit plans; and
WHEREAS, the services provided by Wells Fargo Third Party Administrators are defined in an
Administrative Service Agreement between the Employer and Wells Fargo Third Party Administrators dated
June 15, 2005, as amended on April 16, 2008 and May 20, 2009 (the "Agreement "); and
WHEREAS, the current Agreement is in force and effect until May 20, 2012, however, paragraph 21
of the Agreement specifies that the Agreement may be terminated by either of the parties on thirty (30) days
written notice; and
WHEREAS, the parties now wish to specify the terms and conditions by which Wells Fargo Third
Party Administrator will continue to handle claims during a runout period following termination of the
Agreement in accordance with paragraph 24 of the Agreement.
NOW, THEREFORE, the parties hereto agree as follows:
The administrative fee for Wells Fargo Third Party Administrators, Inc. service for Medical run -out claims
shall be:
1) Ten percent (10%) of total paid claims for the period starting November 1, 2011
through October 31, 2012, which shall be the runout period. Invoices shall be issued
on the 15 and 30 of every month. The Employer agrees to pay Wells Fargo Third
Party Administrators within thirty (30) calendar days following receipt of the proper
invoice of the amount due during the previous billing period. If payment in full is
not received by Wells Fargo Third Party Administrators, Inc. by the due date, the
payment will be considered past due and interest equivalent to twelve percent (12 %)
per year will be charged and paid on the unpaid balance upon the 46 day after
receipt of invoice, or the maximum amount permitted by law, whichever is less.
Wells Fargo Third Party Administrators will immediately suspend its services until
payment is received by Wells Fargo Third Party Administrators.