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Certificates of Insurance ` CERTIFICATE O L ILI Y I U RA t � t> > 1/2412013 PRODUCER 345 -949 -7988 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS 140 R GHTS MARSH MANAGEMENT SERVICES CAYMAN LTD UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE 23 LIME TREE BAY AVENUE COVERAGE AFFORDED BY THE POLICIES BELOW. GOVENORS SQUARE, BUILDING 4, 2 FLOOR PO BOX 1051 COMPANIES AFFORDING COVERAGE GRAND CAYMAN KY1 -1102 cal CAYMAN TSiANDS A PINEAPPLE INSURANCE COMPANY, LTD_ INSURED Baptist Health South Florida, Inc., Baptist Hospital of Miami, COMPANY Homestead Hospital, Manners Hospital, South Miami Hospital, Doctors B Hospital, Baptist Health Enterprise and Baptist Outpatient Services, COMPANY West Kendall Baptist Hospital 6855 Red Road, 5th Floor C Coral Galles, FL 33143 COMPANY Attn: Paige Stone D 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, DE INSURANCE AFFORDEC BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES_ LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS_ E TYPE OF INSURANCE POLICY NUMBER EY MIArDOJYY} DATE r (MMt40tYY1 � S GENERAL UABLITY GENERAL AGGREGATE COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGO. I CLAWS MADE OCCUR. PERSONAL& ADV. INJURY ` OWNER'S & CONTRACTORS PROT EACH OCCURRENCE FVREDAMAGE IAr%aefr ) MED- EXPENSE (APT Dee Pte) AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT ALL OWNED AUTOS BODILY INJURY SCHFnt d FD AUTOS _ (Pet Pte! HIRED AUTOS BODILY INJURY NON -OWNED AUTOS (Per Decedent) _ PROPERTY DAMAGE GARAGE LIABILITY AUTO ONLY - EA ACCIDENT • ANY AUTO OTHER THAN AUTO ONLY: ., EACH Acc DEN ] AGGREGA EXCESS LYtBILtfY EACH OCCURRENCE UMBRW A FORM _ / AGGREGATE 3 OTHER THAN UMBRELLA FORM , �WC WORKER'S COMPENSATICNANO EMPLOYER'S LIABILITY �' — (� _ 'TORY L WIT I I EACH ACCIDENT THE PROPRIETOR/ INCL DISEASE- POLICY LSAT PARTNERS/EXECUTIVE OFFICERS ARE EXCI. DISEASE -EACH EMPLOYEE OTHER HEALTHCARE PROFESSIONAL LIABILITY - PIC 2012/13 10/1/2012 10/1/2013 61,500,000 AGGREGATE A CLAIMS MADE $1,500,000 EACH OCCURRENCE DESCRWTIONS OF OPERATIONSA .00ATIONSIVEIBCLE5ISPECIAL ITEMS Evidencing coverage is in effect. Coverage is subject to all policy terms, conditions and deductibles CER1WK ATE H ANCEU.ATIOUN SHOULD ANY CIF THE ABOVE DESCRM£D POLICIES BE CANCELLED BEFORE THE EXPIRATKNi OATS THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NC Monroe County OBLIGATION OR LIABILITY CF ANY KE4D UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES BOCC Human Resources Administrator AUTHORIZED REPRESENTATIVE 1100 Simonton Street Key West, FL 33040 iftatak iftaucagetIteitt Se uice6 Catgi,ta .W. i AC R � D ATE (MM /DDMlYlr) „�. CERTIFICATE OF LIABILITY INSURANCE 1/24/2012 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 be endorsed. If SUBROGATION 15 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 CONTACT Aon Risk Services, Inc. of Florida NAME: 1001 Brickell Bay Drive A/C. o. Ext): 800- 743 -3486 F No): 305-372-8018 Suite 1100 ADDRESS: Miami, FL 33131 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Samaritan Risk Retention Group 12511 INSURED INSURER B : Baptist Health Medical Group INSURER C : c/o Sandra Perez INSURER D : 6855 Red Road, Ste 200 Miami FL 33143 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MMIDD/YYYY) (MM /DD /YYYY) GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurrence) $ CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 7 POLICY PRO - PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT • (Ea accident) _$ _ ANY AUTO , BODILY INJURY (Per person) $ ALL OWNED SCHEDULED 1 BODILY INJURY (Per accident) $ _ NON -OWNED / PROPERTY DAMAGE HIRED AUTOS AUTOS ^ AUTOS AUTOS `mil! ► � (Per accident) $ UMBRELLA LIAB OCCUR ' EACH OCCURRENCE $ . EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N TORY LIMITS ER ANY PROPRIETOR/PARTNER /EXECUTIVE N / 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 $ Per Claim 5250,000 A Professional Liability N N SPL1062 6/18/2012 6/18/2013 Aggregate $750,000 • DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Coverage includes Professional Liability on a Claims Made Coverage Form. Coverage is provided on a "scope of duties" basis while working for and/or on behalf of Upper Keys Family Medicine Steven Lawyer, DO - Retro Date: 10/16/2006 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Monroe County, BOCC ACCORDANCE WITH THE POLICY PROVISIONS. 1 100 Simonton Street Key West, FL 33040 AUTHORIZED REPRESENTATIVE AON RISK SERVICES © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD