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Certificates of Insurance THE HARTFORD BUSINESS SERVICE CENTER THE ,o 3600 WISEMAN BLVD HARTFORD SAN ANTONIO TX 78251 December 13, 2022 Monroe County BOCC 1100 SIMONTON ST KEY WEST FL 33040 Account Information: QUANTUM HEALTH SOLUTIONS Contact Us Policy Holder Details : INC Need Help? Chat online or call us at (866)467-8730. We're here Monday- Friday. Enclosed please find a Certificate Of Insurance for the above referenced Policyholder. Please contact us if you have any questions or concerns. Sincerely, Your Hartford Service Team WLTRO05 CERTIFICATE OF LIABILITY INSURANCE rA 'M TEM/DD/YYYY) 12/13/2022 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 SUBROGATIONIS 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 USAA INSURANCE AGENCY INC/PHS NAME: 65812846 PHONE (888)242-1430 FAX (A/C,No,Ext): (A/C,No): The Hartford Business Service Center 3600 Wiseman Blvd E-MAIL San Antonio,TX 78251 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: Hartford Casualty Insurance Company 29424 QUANTUM HEALTH SOLUTIONS INC INSURERB: Hartford Underwriters Insurance Company 30104 4873 PALM COAST PKWY NW UNIT 3 INSURERC: PALM COAST FL 32137-3669 INSURER D 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 LTR INSR WVD MM/DD/YYYY MM/DD/YYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $2,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED $300 000 PREMISES Ea occurrence X General Liability MED EXP(Any one person) $10,000 A X 65 SBA TF9660 12/05/2022 12/05/2023 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY❑PRO- LOC PRODUCTS-COMP/OPAGG $4,000,000 JECT OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO APPROVED BY RISK MANAGEMENT BODILY INJURY(Per person) r, ALL OWNED SCHEDULED AUTOS AUTOS DATE �/1 3/202T BODILY INJURY(Per accident) HIRED NON-OWNED WAIVER N/A YES PROPERTY DAMAGE AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- AGGREGATE HMADE DED RETENTION$ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY Y/N E.L.EACH ACCIDENT $1,000,000 B PROPRIETOR/PARTNER/EXECUTIVE N/A 65 WEC GD3821 02/11/2022 02/11/2023 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below A EMPLOYMENT PRACTICES 65 SBA TF9660 12/05/2022 12/05/2023 Each Claim Limit $5,000 LIABILITY Aggregate Limit $5,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Those usual to the Insured's Operations.Certificate holder is an additional insured per the Business Liability Coverage Form SS0008 attached to this policy. CERTIFICATE HOLDER CANCELLATION Monroe County BOCC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 1100 SIMONTON ST BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED KEY WEST FL 33040 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE A,1 12�3 ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD THE HARTFORD BUSINESS SERVICE CENTER THE ,o 3600 WISEMAN BLVD HARTFORD SAN ANTONIO TX 78251 October 25, 2022 Monroe County BOCC 1100 SIMONTON ST KEY WEST FL 33040 Account Information: QUANTUM HEALTH SOLUTIONS Contact Us Policy Holder Details : INC Need Help? Start a live chat online or call us at (866)467-8730. We're here weekdays from 8:00 AM to 8:00 PM ET. Enclosed please find a Certificate Of Insurance for the above referenced Policyholder. Please contact us if you have any questions or concerns. Sincerely, Your Hartford Service Team WLTRO05 CERTIFICATE OF LIABILITY INSURANCE rATE(MM/DD/YYYY) 10/25/2022 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 SUBROGATIONIS 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 USAA INSURANCE AGENCY INC/PHS NAME: 65812846 PHONE (888)242-1430 FAX (A/C,No,Ext): (A/C,No): The Hartford Business Service Center 3600 Wiseman Blvd E-MAIL San Antonio,TX 78251 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: Hartford Casualty Insurance Company 29424 QUANTUM HEALTH SOLUTIONS INC INSURERB: Hartford Underwriters Insurance Company 30104 4873 PALM COAST PKWY NW UNIT 3 INSURERC: PALM COAST FL 32137-3669 INSURER D 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 LTR INSR WVD MM/DD/YYYY MM/DD/YYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $2,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED $300 000 PREMISES Ea occurrence X General Liability MED EXP(Any one person) $10,000 A X 65 SBA TF9660 12/05/2021 12/05/2022 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY❑PRO- LOC PRODUCTS-COMP/OPAGG $4,000,000 JECT OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) HIRED NON-OWNED PROPERTY DAMAGE AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- AGGREGATE MADE DED RETENTION$ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY Y/N E.L.EACH ACCIDENT $1,000,000 B PROPRIETOR/PARTNER/EXECUTIVE N/A 65 WEC GD3821 02/11/2022 02/11/2023 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below A EMPLOYMENT PRACTICES 65 SBA TF9660 12/05/2021 12/05/2022 Each Claim Limit $5,000 LIABILITY Aggregate Limit $5,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Those usual to the Insured's Operations.Certificate holder is an additional insured per the Business Liability Coverage Form SS0008 attached to this policy. CERTIFICATE HOLDER CANCELLATION Monroe County BOCC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 1100 SIMONTON ST APPROVED BY RISK MANAGEMENT BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED KEY WEST FL 33040 gy,,„„ ',,,. m IN ACCORDANCE WITH THE POLICY PROVISIONS. DATE AUTHORIZED REPRESENTATIVE WAIVER N/A YES A,J 12�3 � �2> ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD HEALTHCARE PROVIDERS SERVICE CNA ORGANIZATION PURCHASING GROUP QHP%JQ%�J APPROVED BY RISK MANAGEMENT Certificate of Ngurance OCCURRENCE PROFESSIONAL LIABILITY POLICY FORM Print Date:07/25/22 DATE .. 11/i/262 WAIVER N/A-YES_ The application for the Policy and any and all supplementary Information, materials,and statements submitted therewith shall be maintained on file by us or our Program Administrator and will be deemed attached to and Incorporated Into the Policy as If physically attached. PRODUCER BRANCH I PREFIX POLICY NUMBER Policy Period: 018W8 970 HPG 0270500214 From:08/08/22 to 08/08/23 at 12:01 AM Standard Time Named Insured _ Program Adminls red by: Quantum Health Solutions, Inc. Healthcare Providers Service Organization 4873 Palm Coast Pkwy Nw Unit 3 1100 Virginia Drive, Suite 250 Palm Coast,FL 32137-3669 Fort Washington, PA 19034-3278 215-509-5437 www.hpso.com Medical S eciatt►r Code Insurance ilamided by: Counselor Educator Finn 80723 American Casualty Company of Reading,Pennsylvania Excludes Cosmetic Procedures 151 N. Franklin Street,Chicago,IL 60606 Medical Specialty is amended to include Consulting Services Professional Liablilly Professional Liability $1,000,000 each claim $3,000,000 aggregate Your professional liability limits shown above include the following: •Good Samaritan Liability •Malplacement Liability • Personal Injury Liability •Sexual Misconduct Included in the PL Limit shown above subject to$25,000 aggregate sublimit Coverage Extensions License Protection $25,000 per proceeding $25,000 aggregate Defendant Expense Benefit $1,000 per day limit $25.000 aggregate Deposition Representation $10,000 per deposition $10,000 aggregate Assault $25,000 per incident $25,000 aggregate lnckwes WofWace v"mrarm Counselkv Medical Payments $25,000 per person $100,000 aggregate First Aid $10,000 per Incident $10.000 aggregate Damage to Property of Others $10,000 per incident $10,000 aggregate Enterprise Privacy Protection-Claims Made $25,000 per Incident $25,000 aggregate Retroactive Date:08/08/16-Defense inside limits Media Expense $25,000 per incident $25,000 aggregate Employment Practices Liability(EPL) $25,000 per incident $25,000 aggregate Retroactive Date:08/08/21 - Defense inside limits Workplace Liabill Workplace Liability Included In Professional Liability Limit shown above Fire and Water Legal Liability Included In the PL limit above subject to$150,000 aggregate sublimit Personal Liability Excluded Total:$1,463.70 $1,435.00 PREMIUM$28.70 2022 FIGA Regular Assessment Policy Forms& Endorsements (Please see attached list of policy forms and endorsements) e, 4 O 0 a 0 Chairman of the Board Secretary Keep this document in a safe place.It and proof of payment are your proof of coverage.There is no coverage in force unless the premium is paid in full.In order to activate your coverage,please remit premium in full by the effective date of this Certificate of Insurance. Coverage Change Date: o°a CNA93692(11.2018) Endorsement Date: Master Policy: 188711433 0 Copyright CNA All Rights Reserved. POLICY FORMS &ENDORSEMENTS The following are the policy forms and endorsements that apply to your current professional liability insurance policy. COMMON POLICY FORMS&ENDORSEMENTS FORM# DESCRIPTION G-121600-D(04-08) Common Policy Conditions G-121501-C(07-01) Occurrence Policy Form G-121503-C(07-01) Workplace Liability Form G-145184-A(06-03) Policyholder Notice-OFAC Compliance Notice G-147292-A(03-04) Policyholder Notice-Silica, Mold&Asbestos Disclosure CNA81753(03-15) Coverage&Cap on Losses from Certified Acts Terrorism CNA81758FL(01-21) Notice-Offer of Terrorism Coverage&Disclosure of Premium-Florida GSL13424(05-09) Services to Animals GSL13425(05-09) Business Owner Coverage Extension Endorsement GSL16564(10-09) Sexual Misconduct Sublimits of Liability Professional Liability&Sexual Misconduct Exclusion GSL15565(03-10) Healthcare Providers Professional Liability Assault Coverage GSL17101 (02-10) Exclusion of Specified Activities Reuse of Parenteral Devices and Supplies CNA80052(09-14) Distribution or Recording of Material or Information In Violation of Law Exclusion Endorsement CNA82011 (04-15) Related Claims Endorsement CNA94164(11-18) Amendment Definition of Claim Endorsement CNA85582FL(04-16) Florida Cancellation and Non-Renewal CNA80989(12-14) Concealment,Misrepresentation,Fraud Condition Amendatory Endorsement-Florida CNA88921FL(11-18) Florida Amendatory Change for EPL CNA79516(07-14) Enterprise Privacy Protection CNA79575(07-14) Exclusion of Cosmetic Procedures CNA89026(05.17) Media Expense Coverage CNA93658(08-18) Employment Practices Liability Coverage-Defense Only G-123828-B(07-01) Certificate Holder G-141231-A(07-01) Additional Insured Healthcare Entity GSL-5587(11-05) Consulting Services Liability Endorsement GSL13428(05-09) DBA or Specified Endorsements Healthcare Providers Service Organization Is a registered trade name of Affinity Insurance Services,Inc.;(TX 13695);(AR 100106022);in CA, MN,AIS Affinity Insurance Agency,Inc.(CA 0795465);in OK, AIS Affinity insurance Services,Inc.; in CA,Aon Affinity Insurance Services, Inc.,(CA 0G94493),Aon Direct Insurance Administrators and Serkely Insurance Agency and In NY,AIS Affinity Insurance Agency. Form#:CNA93692(11-2018) Named Insured:Quantum Health Solutions,Inc. Master Policy*.,188711433 Policy#:0270500214 HEALTHCARE PROVIDERS SERVICE CNAoR Leittf% ite of 3htt5ttt'o Yce UP OCCURRENCE POLICY FORM WHPSO Print Date: 6123117 0202000020 PRODUCER BRANCH PREFIX POLICY NUMBER 018098 970 HPG 0270500214 Named Insured Quantum Health Solutions, Inc. 4873 Palm Coast Pkwy NW Unit 3 Palm Coast, FL 32137-3669 Medical Specialty Code Counselor Educator Firm 80723 Excludes Cosmetic Procedures Professional Liabilit Policy Period: From 08/08/17 to 08/08/18 at 12:01 AM Standard Time Proaram Administered bv: Healthcare Providers Service Organization 159 E. County Line Road Hatboro, PA 19040-1218 1-888-288-3534 www.hpso.com Insurance is provided by: American Casualty Company of Reading, Pennsylvania 333 South Wabash Avenue, Chicago, IL 60604 Professional Liability $1,000,000 each claim $3,000,000 aggregate Your professional liability limits shown above include the following: - Good Samaritan Liability • Malplacement Liability • Personal Injury Liability • Sexual Misconduct included in the PL Limit shown above subject to $25,000 aggregate sublimit Coverage Extensions License Protection $25,000 per proceeding $25;000 aggregate Defendant Expense Benefit $1,000 per day limit $25,000 aggregate Deposition Representation $10,000 per deposition $10,000 aggregate --- Assault $25,000 per incident $25,000 aggregate Includes Workplace Violence Counseling Medical Payments $25,000 per person $100,000 aggregate First Aid $10,000 per incident $10,000 aggregate Damage to Propery of Others $10,000 per incident $10,000 aggregate Enterprise Privacy Protection - Claims Made $25,000 per incident $25,000 aggregate Retroactive Date: 08/08/16 (Defense inside limits) Workplace. Liability Workplace Liability Included in Professional Liability Limit shown above Fire and Water Legal Liability Included in the PL limit above subject to $150,000 aggregate subliiit Total: $920.00 Base Premium:'$920.00 APPR E t�GIMENIf/R(c�ty� Y �1cw— WAIVER /A YFS cc-. f, te Policy Forms & Endorsements (Please see attached list for a general description of many common policy forms and:endorsements.) G-121500-D G-121501-C G-121503-C G-145184-A G-147292-A CNA81753 CNA81758 GSL13424 GSL13425 6SL15564 GSL15565 GSL17101 CNA80052 CNA82011 G-123846-D09 CNA80989 G-123828-B CNA79575 CNA79516 G51-5587 GSL13428 Medical Speciality is amended to include Consulting Services (GSL5587) . Keep this document in a safe place. It and proof of payment are your proofof r� �] coverage. There is no coverage in force fj j C unless the premium is paid in full. In order to activate your coverage, please Chairman of the B and Secretary remit premium in full by the effective date of this Certificate of Insurance. Form #: G-141241-B ,Jc�� Master Policy #: 188711433 L� POLICY FORMS & ENDORSEMENTS The following are the policy forms and endorsements that apply to your current professional liability insurance policy. COMMON POLICY FORMS & ENDORSEMENTS FORM # DESCRIPTION G-121500-D Common Policy Conditions G-121501-C Occurrence Policy Form G-121503-C Workplace Liability Form G-145184-A Policyholder Notice - OFAC Compliance Notice G-147292-A Policyholder Notice - Silica Mold & Asbestos Disclosure CNA81753 Cap on Losses from Certified Acts of Terrorism CNA81758 Notice Offer of Terrorism Coverage Disclosure of Premium Confirmation of Acceptance GSL13424 Services to Animals GSL13425 Business Owner Coverage Extension Endorsement GSL15564 Sexual Misconduct Sublimits of Liability Professional Liability & Sexual Misconduct Exclusion GSL15565 Healthcare Providers Professional Liability Assault Coverage GSL17101 Exclusion of Specified Activities Reuse of Parenteral Devices and Supplies CNA80052 Distribution or Recording of Material or Information in Violation of Law Exclusion Endorsement CNA82011 Healthcare Providers Related Claims Endorsement G-123846-D09 Florida Cancellation and Non -Renewal CNA80989 Concealment Misrepresentation Fraud Condition Amendatory Endorsement Florida OPTIONAL ENDORSEMENTS FORM # DESCRIPTION G-123828-B Certificate Holder CNA79575 Cosmetic Procedures Exclusion CNA79516 Enterprise Privacy Protection Endorsement GSL5587 Consulting Services Liability Endorsement GSL13428 DBA or Specified Location Endorsement Healthcare Providers Service Organization is a registered trade name of Affinity Insurance Services, Inc.; (TX 13695); (AR 100106022); in CA, MN, AIS Affinity Insurance Agency, Inc. (CA 0795465); in OK, AIS Affinity Insurance Services, Inc.; in CA, Aon Affinity Insurance Services, Inc., (CA OG94493), Aon Direct Insurance Administrators and Berkely Insurance Agency and in NY. AIS Affinity Insurance Agency. Form M G-141241-8 Named Insured: Quantum Health Solutions, Inc. Master Policy #: 188711433 Policy M 0270500214 sa�J`ra CERTIFICATE OF LIABILITY INSURANCE (M VDD/YYYY) 11/11/2017 THIS CERTIFICATEIS 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 endorsements . PRODUCER USAA INSURANCE AGENCY INC/PHS 812846 P: (888) 242-1430 F: (888) 443-6112 PO BOX 33015 SAN ANTONIO TX 78265 CONTACT NAME: (A/C,PHONE (888) 242-1430 i .No): (888) 443-6112 A -MAIL INSURER(S) AFFORDING COVERAGE NAIL.." INSURER A: Hartford' Casualty Ins Co INSURED QUANTUM HEALTH SOLUTIONS INC 4873 PALM COAST PKTATY NW UNIT 3 PALM COAST FL 32137 INSURERB: MUltiple Companies INSURER C: INSURER D: 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. "SR nPEOFdYSURANCE ADDI INSRI SUBB POLICYNIVISMLR POLICYEFF (AfA1/DD/ITI7 POLICYEXI' LCID'TS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $2 , 000,000 CLAIMS -MADE OCCUR DAMAGE TO RENTED s300,000 PREMISES (Ea occurrence) X X MEDEXP(Any on. parson) $10, 000 A General Liab 65 SBA TF9660 12/05/2017 12/05/2018 PERSONAL & ADV INJURY s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE s4,000,000 POLICY 1 PRO � LOC JECT PRODUCTS - COMP/OP AGG s4,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS PROPERTY DAMAGE HIRED NON -OWNED AUTOS ONLY AUTOS ONLY (Per accident) $ $ UMBRELLAIJA0 OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DE RETENTION $ WORSERSCOMPENSATION X PER OTH- STATUYE ER M'DEAMPLOrLIIS'LLIB&M E.L. EACH ACCIDENT $1 , 000, 000 ANY PROPRIETOR/PARTNER/EXECUTIVEY/N B OFFICER/MEMBER EXCLUDED? (Mandatoiy2NH) N/A 65 TnTEC GD3821 02/11/2017 02/11/2018 E.L DISEASE -EA EMPLOYEES I, 000, 000 If yes, describe under E.L. DISEASE -POLICY LIMIT $1 0 0 0, 0 0 0 DESCRIPTION OF OPERATIONS below , DESCRIPTION OF OPERATIONS /LOCATIONS/VEHIOPMRD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. Monroe County BOCC is additional insured per the business liability coverage form ss0008. tNT E- gY V B A O L(mc- WAIVER A ES_ _ CL;-F71e Mur I' a- -'13em e'�l CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. MONROE COUNTY BOCC 1100 S IMONTON ST / A�UT{H�ORIZEDREPRESENTATIVE CJ� CGlQ7`rz�> KEY WEST, FL 33040 c%'� U 1988-2015 ACORD CORPORATION. All rights reserve ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE 22/2018 THIS CERTIFICATEIS 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). USAA INSURANCE AGENCY INC/PHS (A/cN..Ext): (888) 242-1430 (allo): (888) 443-6112 812846 P: (888) 242-1430 F: (888) 443-6112 q RESS: PO BOX 33015 INSURER(S) AFFORDING COVERAGE NAICB SAN ANTONIO TX 78265 INSURER A: Hartford Casualty Ins Co INSURED INSURERS: Multiple Companies INSURER C: QUANTUM HEALTH SOLUTIONS INC INSURER D: 4873 PALM COAST PKWY NW UNIT 3 INSURER E: PALM COAST FL 32137 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. RVSR TYPEOFEVSIZA"CE ADD SUBA POLICYAVAMER rOL.ID EFF POLICYEXP LLUM COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s2,000, 000 CLAIMS -MADE 7 OCCUR DAMAGETO RENTED PREMISES (Ea occurrence) $1 O O O 000 X X MEDEXP(Any onaperson) s10, 000 A General Liab 65 SBA PS3897 02/17/2018 02/17/2019 PERSONAL BADVINJURY s2, 000, 000 GEN'LAGGREGATE LIMIT APPLIES PER POLICY JE T ❑X LOC GENERAL AGGREGATE s4,000, 000 PRODUCTS -COMP/OP AGG SLR 10 r 000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) S2 0 0 O 000 r i BODILY INJURY (Per person) $ ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS 65 SBA PS3897 02/17/2018 02/17/2019 BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY S UMBRELLA UAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE D RETENTION S $ A4 1V0AKEC0WPMVSA7/ON ANDFAMOYEBS'LL3BBSl7 ANY PROPRIETOR/PARTNER/EXECUTIVB7N X PER OTH- ISTATUTE I JER E.L. EACH ACCIDENT $1, 0 0 0, 000 B OFFICER/MEMBEREXCLUDED? ❑ (Mandatory in NH) wA 65 WEC GD3821 02/11/2017 02/11/2018 E.L. DISEASE -EAEMPLOYEE 11, 000, 000 If yes, describe under DESCRIPTION OF OPERATIONS below-F E.L. DISEASE -POLICY LIMIT Ill , 0 0 0, 0 0 0 T DESCRIP77ON OF OPERATIONS /LOCATIONS /VEHIgMMRD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. Monroe County BOCC is add'ti insured per the business liability coverage form ss0008. APPR ED EMENT 43v peyk.. WAIVE N/A,- y. S_ C[. ,.-,h � Jl4Xi4=�lht,�-rl�1 CERTIFICATE HOLDER CANCELLATION V MONROE COUNTY BOCC 1100 SIMONTON ST KEY WEST, FL 33040 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 REPRESENTA77VE ACORD 25 (2016103) ©1988-2015 ACO The ACORD name and logo are registered marks of ACORD resen HEALTHCARE PROVIDERS SERVICE MHPSO CNAORGANIZATION PURCHASING GROUP Certificate of luntrance Hulrhmm Pmvi&r% Scmice Orpniatima OCCURRENCE POLICY FORM Print Date: 6/08/2016 Producer Branch Prefix Policy Number Policy Period 018098 970 HPG 0270500214 from 08/08/16 to 08/08/17 at 12:01 AM Standard Time Named Insured and Address: Quantum Health Solutions, Inc. 4873 Palm Coast Pkwy Nw Unit 3 Palm Coast, FL 32137-3669 Medical Specialty: Counselor Educator Firm Excludes Cosmetic Procedures Program Administered by: Healthcare Providers Service Organization 159 E. County Line Road Hatboro, PA 19040-1218 1-888-288-3534 www.hpso.com Code: Insurance is provided by: 80723 American Casualty Company of Reading, Pennsylvania 333 S. Wabash Avenue, Chicago, IL 60604 Professional Liability $1,000,000 each claim $ 3,000,000 aggregate Your professional liability limits shown above include the following: • Good Samaritan Liability • Malplacement Liability Personal Injury Liability • Sexual Misconduct Included in the PL limit shown above subject to $ 25,000 aggregate sublimit Coverage Extensions License Protection $ 25,000 per proceeding $ 25,000 aggregate Defendant Expense Benefit $ 1,000 per day limit $ 25,000 aggregate Deposition Representation $ 10,000 per deposition $10,000 aggregate Assault $ 25,000 per incident $ 25,000 aggregate Includes Workplace Violence Counseling Medical Payments $ 25,000 per person $100,000 aggregate First Aid $10,000 per incident $10,000 aggregate Damage to Property of Others $ 10,000 per incident $10,000 aggregate Enterprise Privacy Protection - Claims Made $ 25,000 per incident $ 25,000 aggregate Retroactive Date: 8/08/2016 (Defense inside limits) Workplace Liability Workplace Liability Included in Professional Liability Limit shown above Fire & Water Legal Liability Included in the PL limit shown above subject to $150,000 aggregate sublimit Total: $ 830.00 Base Premium AP O ANAGEME:NT ra��gr,�yti� BY erg WAN • N AP Policy Forms & Endorsements(Please see attached list for a general description of many common policy forms and endorsements.) G-121500-D CNA80989 G-121503-C G-121501-C G-145184-A G-147292-A GSL15564 GSL15565 GSL17101 GSL13424 GSL13425 CNA80052 G-123846-1309 CNA81753 CNA81758 CNA82011 CNA79516 G-123828-B GSL13428 CNA79575 GSL-5587 Medical Speciality is amended to include Consulting Services (GSL-5587) Keep this document in a safe place. it /1 � p _ f _ and proof of payment are your proof of V400--� oTL coverage. There is no coverage in force � � tJ'��/ 1�``Q��` ' unless the premium is paid in M.In order Chairman of the Board Secretary to activate your coverage, please remit premium in full by the effective date of this Certificate of Insurance. ' Master Policy # 188711433 G-141241-B (03/2010) Coverage Change Date: Endorsement Change Date: POLICY FORMS & ENDORSEMENTS The list below contains general descriptions of the policy forms and endorsements that may or may not apply to your professional liability insurance policy. Please refer to your Certificate of Insurance for the policy forms & endorsements specific to your state and your policy period. Coverages, rates and limits may differ or may not be available in all states. All products and services are subject to change without notice. Think Green -expanded definitions and copies of these policy forms and endorsements are available online at www.hpso.com/policyforms COMMON POLICY FORMS & ENDORSEMENTS FORM # DESCRIPTION G-121500-D Common Policy Conditions CNA80989 Concealment, Misrepresentation, Fraud Condition Amendatory Endorsement - Florida GA21503-C Workplace Liability Form GA21501-C Occurrence Policy Form G-145184-A Policyholder Notice - OFAC Compliance Notice G-147292-A Policyholder Notice - Silica, Mold & Asbestos Disclosure GSL15564 Sexual Misconduct Sublimits of Liability Professional Liability & Sexual Misconduct Exclusion GSL15565 Healthcare Providers Professional Liability Assault Coverage GSL17101 Exclusion of Specified Activities Reuse of Parenteral Devices and Supplies GSL13424 Services to Animals GSL13425 Business Owner Coverage Extension Endorsement CNA80052 Distribution or Recording of Material or Information in Violation of Law Exclusion Endorsement G-123846-D09 Florida Cancellation and Non -Renewal CNA81753 Coverage & Cap on Losses from Certified Acts Terrorism CNA81758 Notice - Offer of Terrorism Coverage & Disclosure of Premium CNA82011 Related Claims Endorsement CNA79575 Exclusion of Cosmetic Procedures OPTIONAL ENDORSEMENTS FORM # DESCRIPTION CNA79516 Enterprise Privacy Protection G-123828-B Certificate Holder GSL13428 DBA or Specified Endorsementns GSL-5587 Consulting Services Liability Endorsement PLEASE REFER TO YOUR CERTIFICATE OF INSURANCE FOR THE POLICY FORMS & ENDORSEMENTS SPECIFIC TO YOUR STATE AND YOUR POLICY PERIOD. For NJ residents: The PLIGA surcharge shown on the Certificate of Insurance is the NJ Property & Liability Insurance Guaranty Association. For KY residents: The Surcharge shown on the Certificate of Insurance is the KY Firefighters and Law Enforcement Foundation Program Fund and the KY LGPT is the KY Local Government Premium Tax which includes charges at a municipality and/or county level. For WV residents: The surcharge shown on the Certificate of Insurance is the WV Premium Surcharge. For FL residents: The FIGA Assessment shown on the Certificate of Insurance is the FL Insurance Guaranty Association - 2012 Regular Assessment. Form#:G-141241-B (03/2010) Named Insured: Quantum Health Solutions, I Master Policy#:188711433 Policy#: 0270500214 ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MWDD/YYYY) 12/7/2014 THIS CERTIFICATEIS 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 SUBROGATIONIS 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 USAA INSURANCE AGENCY INC/PHS 812846 P: (888) 242-1430 F: (888) 443-6112 PO BOX 33015 SAN ANTONIO TX 78265 CONTACT NAME: NE (NC,No, Ext): (888) 242-1430 (AC.No): (888) 443-6112 ADDRIESS: INSURER(S) AFFORDING COVERAGE NAICN INSURERA: Hartford Casualty Ins Co INSURED QUANTUM HEALTH SOLUTIONS INC 4873 PALM COAST PKWY NW UNIT 3 PALM COAST FL 32137 INSURER B : INSURER C : INSURER D: 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 POLICYNUWER POLICTEFF POLICT19w LLIH7N COMMERCIAL GENERAL LUU31LrrY EACH OCCURRENCE s2,000,000 CLAIMS -MADE � OCCUR DAMAGE TO RENTED occurrence.)s300,000 PREMISES (Ea occurrence.) X X MED EXP (Any one person) s10, 000 A General Liab 65 SBA TF9660 12/05/2014 12/05/2015 PERSONAL SADVINJURY s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY Ei JECT PRO LOC GENERAL AGGREGATE s4,000,000 PRODUCTS - COMP/OP AGG s4,000,000 $ OTHER: AUTOMOBILE L1ABILRY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS AP PRO IN /A .� L (i II n (/ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ s UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE AGGREGATE $ DE RETENTION $ S WORKERS CDMPENSATION ANDEMPLOTEBSLL487LIIT ANY PROPRIETOR/PARTNER/EXECUTIVEY/N PER OTH- STATUTE ER E.L. EACH ACCIDENT $ OFFICEWMEMBER EXCLUDED? El(��ft,�,InN/I) WA E.L. DISEASE -EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCR/PTIONOFOPERATIONS /LOCATIONS / VEHKPMRD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. Monroe County BOCC is additional insured per the business liability coverage form ss0008. t11;'AAAOJ 3UNOW P`coTrrrf`ATC Unr nGe CAMrFI IOTION ------- ----- --- •n 1 J� 7 330 h101 O I� C• 3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORED REPRESENTATIVE t MO NRO E COUNTY O 3 3 d 8 0 J 0311 i U O 1100 SIMONTON ST KEY WEST, FL 33040 ACORD 25 (2014/01) V 7`Joo-AU74 AVVKU vumr VKA IVIY The ACORD name and logo are registered marks of ACORD All rights reserved, ►co V CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 1/31/2015 THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICA' CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED B BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER( REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATIONIS' terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not certificate holder in lieu of such endorsement(s). HOLDER. THIS THE POLICIES , AUTHORIZED ), subject to the rights to the USAA INSURANCE 812846 P: (888) PO BOX 33015 SAN ANTONIO TX AGENCY INC/PHS 242-1430 F: (888) 78265 443-6112 NC,"N.E:t} (888) 242-1430 (ac.No) (888) 443-6112 ADDRIESS: INSURERS) AFFORDING COVERAGE NAIL# INSURERA: Hartford Casualty Ins Co INSURED QUANTUM HEALTH SOLUTIONS INC 4873 PALM COAST PKWY NW UNIT 3 PALM COAST FL 32137 ......ewe. INSURER B: Multiple Companies INSURER C : INSURER D' INSURER E: INSURER F: RFVISIAN NUMBER: %.V YLK/417C.7 vr.. ... ...-...........�-... THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. FOR THE POLICY PERIOD RESPECT TO WHICH THIS SUBJECT TO ALL THE WSR TYPE OF INSURANCE ADDI SUBX POLICYNUMBER POLICYEFF POLICYEXP LIMAS EACH OCCURRENCE 5 2, 000, 000 COMMERCIAL GENERAL LIABILITY C CLAIMS -MADE � OCCUR PREM SERENTED S ETO occ rrence) $1O O O O O O , , A General Liab 65 SBA PS3897 02/17/2015 02/17/2016 X X MED EXP (Any onePerson) s10, 000 PERSONAL & ADV INJURY s 2, 000, 000 GENERAL AGGRETE A, , 000, 000 GENT AGGREGATE LIMIT APPLIES PER: RO Fx]LOC POLICY F--] PRO- PRODUCTS - COM /OP AGG s 4 , 000, 000 $ JECT OTHER AUTOMOBILE LIABILITY COMBINED SINGLE (Ea accident) LIMIT s2,000,000 BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (P accident) $ A ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON -OWNED AUTOS 65 SBA PS3897 02/17/2015 02/17/2016 PROPERTY (Per accident)DAMAGE $ S UMBRELLA LIAR OCCUR EACH OCCURRENCE $ I AGGREGATE $ EXCESS LU\B CLAIMS -MADE 5 D RETENTION S WORCEpC COMPENSATION AND EMPLOTFJW LLIBILnT ANY PROPRIETOR/PARTNER/EXECUTIVEY/N PER X STATUTE _ ERR E.L. EACH ACCIDENT 51 , 0 0 0, 0 0 0 B OFFIdaWryi Njq) EXCLUDED? ❑ (Mandatory in IWQ If yes, describe under WA 65 WEC CD3821 02/11/2015 02/11/2016 E.L. DISEASE -EA MPLOYEE $1, 000, 000 E.L. DISEASE - PO ICY LIMIT $1 , 0 0 DESCRIPTION OF OPERATIONS below DESCRFgMOFOPERATIONS/LOCATIOVS/ VEH/CINIZIRD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. Monroe County BOCC is do al insured per the business liability coverage form ss0008. AP4 G WA V / _ NT CtKIIVII:AIt PIVLUCK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY_PROVISIONS. Aurmom EDREPRESEVTAnm MONROE COUNTY BOCC 1100 SIMONTON ST 79--z— KEY WEST, FL 33040 �wnoo nnww wrnon o-r%oons ATIn IJ All rin6+¢ ra¢ary ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD l DATeIheUDo+YYYT► ►co & CERTIFICATE OF LIABILITY INSURANCE 1/31/2015 THIS CERTtF1C Wn ISSUED AS A MATTER OF WORAATM ONLY AND COWERSOKO THE I TS UpO14 T HOcRDirD BY TF WEP- THIS s CERTIFICATE DOES NOT AFFIRM TIVELY OR NEGATIVELY AMEND, EXTEND BELOW. THIS CERT[FtCATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE issum INSURER(n AUTHORIZED RpRESENTATIVE OR pRODUCEg, AND THE CERTIFICATE HOLDER es endorsed. R sUBROGATIONIS WAIVED, subject to the IMPORTANr: to the oert8aate holder is an ADOIRONAL INSUR. the Pooromy(i ) must be titans and eont5do hs of 1lho potay, min P �Y FireEDen endorsement. A stabesnent on this osrttieaie does not oonfar rights fa Ire certtie b holder in 6eu of such endorsement(s). USAA INSURANCE AGENCY INC/PHS 812846 P:(888) 242-1430 F:(888) 443-611 PO BOX 33015 SAN ANTONIO TX 78265 0300 QUANTUM HEALTH SOLUTIONS INC 4873 PALM COAST PKWY NW UNIT 3 PALM COAST FL 32137 PHOW enr (888) 242-1430 ua AFRMNOCaveRAW A:Hartford Casualty Ins Co wsuamte: Multiple Companies a�ewteaC: DOURN o: amuaete: ROURG1P: (888) 443-6112 DVERAGES CERTIFICATE RUa![Urnrs: POLICY - THIS G TO CERTIFY THAT THE POLICIES OF WSURANCE LISTED BELOW HAVE BEEN ISSUED TOOTFRIEINSURED NAMED ABOVE FOR THE OTHER DOCUMENT W� RESPECT WH�THIS DATED. NOTWITHSTANDING ANY REQUIREMENT. TE RM OR CONDITION OF ANY �� DESCRIBED HEREIN � �� TO qu THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED THtMS.EXCLUStONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Lamf 0FAVSE Sw potrerA mt .. 79q EACH OCCURRENCE 2,000,000 pAIMMA E i JOCCUR A X General Liab X 65 SBA PS3897 GMAGGREmN umff APPUES PSt „a J a LOC ANY AUTO A ZSSNM AUTOS 65 SBA PS3897 Alr1O5 X HMO X AUTOS WFaRs1ALIAa OCCUR m r. r. UAs C.AIph&MME PRE7re8F8 aoaunanas 1,000,000 02/17/2015 02/17/2016 &MOM n�eP ) h10, 000 PERSpkALAADVwuRY 2, 000, 000 G84MLAGIM ECATE 4 000 000 PR=UCTs.cau~am4, 000, 000 BODILY WARY ew vow* 02/17/2015 02/17/2016 BOOILY0rJURYOWa008A EACH 0CGURR6\CE AGGREGATE 000, 000 nm�r�y.�r E..EACHACCOENT 11000, 000 ANYPROPR�TORJPMUNBUDEDiTI M B ��) 0=02? a ws 65 WEC GD3821 02/11/2015 02/11/2016 � '� 1, 000, 00 E.LDISEASE.POUCYLUT 11,000,000 a V. ahhaes juvw no>rDISOCIMoFOPerAnarsiixaTWW1Venegas>�,o+.Ad�+►oo.+R s�Iwa.111 a,a+�reo noaa�noNof Those usual to the Insured's Operations. Monroe County BOCC is additional insured per the business liability coverage form ss0008. APPR04 2 GEIV)FSN BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL B MDNROE COUNTY BOCC •-- • 1100 SMNTON ST KEY WEST, FL 33040 ®1888-2 14 ORD CORE ACORD 25 (2114101) The ACORD nano and logo are registered marks of ACORD NA Producer Branch Prefix 018098 970 HPG HEALTHCARE PROVIDERS SERVICE ORGANIZATION PURCHASING GROUP (tert(firate of 35119urallck OCCURENCE POLICY FORM Print Date, 1112512014 Policy Number Policy Period 0270500214 from 08/08114 to Oat0811sal 12:01 AM Standard Time Named Insured and Address: Program Administered by. - Quantum Health Solutions, Inc. Healthcare Providers Service Organization 073 Palm Coast Pkyfy Nw Unit 3 159 E. County Line Road Palm Coast, Fl. 32137-3669 Hatboro, PA 19040-1218 I-888-288-3534 WvNe.hpso.com Medical Specialty: Code: Insurance is provided by: Counselor Educator Firm 80723 American Casualty Company of Reading, Pennsylvania Excludes Cosmetic Procedures 333 S. Wabash Avenue, Chicago, IL 60604 Professional Liability 1,00D,000 each claim $ 3,000,DO0 aggregate Your professional liability limits shmvn above include the follovAng; * Good Samaritan Liability 'r Malplacement Liability r Personal Injury Liability * Sexual Misconduct Included in the PL limit shown above subject to S 25,D00 aggregate sublimit Coverage Extensions License Protection S 2 5, 0 LX-� per praceeding S 25. DW ag-giecale Defendant Expense merit S 1,000 per day limit S 25'Wo m;,qr"te Deposition Representation S 10,000 per deposition S 1 Cl:' CGO aggregate Assault 9 255,09�) per incidert, S 25, ODD aggregate Inckides Workplace Violence Counseling Medical Payments S 25.000 per person S 100:000 aggregate First Aid S 10,0W per inciderA S 10, =1 aggit'(2ale Darriage to Property of Qtl�er5 S 10,0DD per incident S 10,ODD aggregate Information Privacy (HIPAAFines, and Penalties S 25,00D per incident 5 25, ODD aggregate Workplace Liability Worloace Liability Included in PrDfeisional Liability Limit shown above Fife & Water Legal Liability Included In the PL limit shown above subject to S150.000 aggregate sublimit Total: $ 8118.02 A P Base Premium ANAG6EMENT LtY(VW*&t WA WAIVER S %2' YES AIVER N/A Policy Forms & Endorsoments(Please see attached list fora general description Of many common policy forms andL' endorsements.) G-12154D-D G-121503-C G-121501-C G-145184-A G-147292-A GSLI 5563 GSLI5564 GSL16565 308t%t134,24NJ GSL1 $425 G-123846-C29 GSL3886 GSL3908 G ii�� G81-*428 GSLI "04 GSL-5587 Medical Speciality is amended to inn 11dP f,-n -5587) V A" 7 7-rWT fti%%VqJ*es Keep tfts dowm en t in a sofa #a-- e . it and 0100f 0f,0,&Me(9 are your proof of coverage. Thwv is rev coveravq,�' fake CC IAJ*4A 1777TWJ';7� V unless the premitm is paid An fuX. In order Chairman of the Board Secretary br 'J aclivate yokff COV&'89e, Jgp'a" to premium in f..1 by (he of edive dafe of Ws CsM-'66a.+e of Insuranca. Master Policy # 188711433 At-1 Al ?A1 -A (Olt" I ni Coverage Change Date., Endorsement Change Date- POLICY FORMS & ENDORSEMENTS The list below contains general descriptions of the policy forms and endorsements that may or may not apply to your professional liability insurance policy. Please refer to your Certificate of Insurance for the policy forms & endorsements specific to your state and your policy period. Coverages, rates and limits may differ or may not be available in all states. All products and services are subject to change without notice. Think Green —expanded definitions and copies of these policy forms and endorsements are available online at www.hpso.com/pollcyfoffns COMMON POLICY FORMS & ENDORSEMENTS FORM # DESCRIPTION G-121500-D Common Policy Conditions 0-121503-C Workplace Liability Form G-121601-C Occurrence Policy Form 0-145184-A Policyholder Notice - OFAC Compliance Notice G-147292-A Policyholder Notice - Silica, Mold & Asbestos Disclosure GSL15563 Information Privacy Coverage Endorsement HIPAA Fines. Penalties & Notification Costs GSL15564 Sexual Misconduct Sublimity of Liability Professional Liability & Sexual Misconduct Exclusion GSL15565 Healthcare Providers Professional Liability Assault Coverage GSL17101 Exclusion of Specified Activities Reuse of Parenteral Devices and Supplies GSL13424NJ Services to Animals - New Jersey GSL13425 Business Owner Coverage Extension Endorsement G-123046-029 Nevi Jersey Cancellation and Non -Renewal GSL3888 Coverage & Cap on Losses from Certified Acts Terrorism GSL3908 Notice - Offer of Terrorism Coverage & Disclosure of Premium GSL19904 Exclusion of Cosmetic Procedures OPTIONAL ENDORSEMENTS FORM # DESCRIPTION G.112308.0 Certificate Holder GSL13428 DBA or Specified Endorsementns GSL-5587 Consulting Services Liability Endorsement PLEASE REFER TO YOUR CERTIiFICATE OF INSURANCE FOR THE POLICY FORMS & ENDORSEMENTS SPECIE TO YOUR STATE AND YOUR POLICY PERIOD. For NJ residents: The PLIGA surcharge shown on the Certificate of Insurance is the NJ Property & Liability Insurance Guaranty Association. 1� lt�►^IUU 30dHOW For KY residents: The Surcharge shown on the C�rt�d�at�of Insurance is the KY Firefighters and Law Enforcement Foundation Program Fund and the KY LGPT is the KY Local Government Premium Tax which includes charges at a m". arLd 89unwlevel. For WV residents: The surcharge shown on the Certlflcate o nyrance is the WV Premium Surcharge. For FL residents: The FIGA Assessment shown on the Certificate of Insurance is the FL Insurance Guaranty Associatii - 2012 Regular Assessment. Fomt#:G-141241-B (0312010) Named Insured:Quantum Health SOIL Master PolicyM 188711433 Policy#: 0270500214 HEALTHCARE PROVInERS SERVICE 4�AM ORGANIZATION PURCHASING GROUP ®IHPSO certificate of X 5ttrailice n-l—r....:. -sue..-.«a>.i.....�.....,- OCCURENCE POLICY FORM Print [Date: 6/23/2015 Producer Branch Prefix Policy Number Policy Period 018098 970 HPG 0270500214 from 08/08/15 to 08/08/16 at 12:01 AM Standard Time Named Insured and Address: Program Administered by: Avant-vn Health SOlutions, Inc. Healthcare Providers Service Organization 4873 Palm Coast Pkwy Nw U-U.S 159 E_ County Line Road Palm Coast, FL 32137-3669 Hatboro, PA 19040-1218 1-888-288-3534 www_ h pso. co m Medical Specialty: Code: Insurance is provided by: Counselor Educator Firm 80723 American Casualty Company of Reading, Pennsylvania 333 S_ Wabash Avenue, Chicago, IL 60604 Excludes Cosmetic Procedures Professional Liability S 1 ,000,000 each claim S 3.000,000 aggregate Your professional liability limits shown above include the following: Good Samaritan Liability Malplacement Liability - Personal Injury Liability Sexual Misconduct Included in the PL limit shown above subject to S 25,000 aggregate sublimit Coverage Extensions License Protection S 25,000 per proceeding S 25,000 aggregate Defendant Expense Benefit S 1,000 per day limit S 25,000 aggregate Oeposition Representation S 10,000 per deposition S-10,000 aggregate Assault S 25,000 per incident S 25,000 aggregate Includes Workplace Violence Counseling Medical Payments S 25,000 per person S 1 00,000 aggregate First Aid S 10,000 per incident S 10,000 aggregate Damage to Property of Others S 10,000 per incident S 10,000 aggregate Information Pri—y (HIPAA) Fines and Penalties S 25,000 per incident S 25,000 aggregate Workplace Liability Workplace Liability Included in Professional Liability Limit shown above Fire a Water Legal Liability Included in the PL limit shown above subject to S150.000 aggregate sublimit Total: S 730.00 Base Premium Rllrvp v-ENAEN7 WAIV N/A VVESCG oT• �Z- Policy Forms & Endorsements(Please see attached list for a general description of many common policy forms and endorsements.) G-121500-0 GSL7412FL G-121503-C G-121501-C G-145184-A G-147292-A GSL15563 GSL15564 G1-31-15565 GSL17g1�0g1 GSL13424 GSL13425 G-123846-009 GSL3886 GSL13428 CNA79575 Gt$Li3J9fH31 tiitC?j �U12 GSL-5587 C uW-B ?iiU Medical Speciality is amended to include Consulting Services (GSL-5587) Keep this document in a safe p/ace./t and proof of payment era your proof of �/�.{(, {//'� � coverage. Thera is no coverage in force �rh ili�" un/ass the premium is Paid in fu0./n order Chairman of the Board i_f tj [j;J� �� e�Ttary to activate your covetmga, p/aase remit r y premium in fu// by the eHectiva data of thrs CartrTicata of /assurance. etCa aG-141241-B (03/201O) Govera a Chan a Oate: EndorsmenhgpMT11433 POLICY FORMS & ENDORSEMENTS The list below contains general descriptions of the policy forms and endorsements that may or may not apply to your professional liability insurance policy. Please refer to your Certificate of Insurance for the policy forms & endorsements specific to your state and your policy period. Coverages, rates and limits may differ or may not be available in all states. All products and services are subject to change without notice. Think Green —expanded definitions and copies of these policy forms and endorsements are available online at www.hpso.com/policyforms COMMON POLICY FORMS & ENDORSEMENTS FORM # DESCRIPTION G-121500-D Common Policy Conditions GSL7412FL Florida Amendatory Endorse G-121503-C Workplace Liability Form G-121501-C Occurrence Policy Form G-145184-A Policyholder Notice - OFAC Compliance Notice G-147292-A Policyholder Notice - Silica, Mold & Asbestos Disclosure GSL15563 Information Privacy Coverage Endorsement HIPAA Fines, Penalties & Notification Costs GSL15564 Sexual Misconduct Sublimits of Liability Professional Liability & Sexual Misconduct Exclusion GSL15565 Healthcare Providers Professional Liability Assault Coverage GSL17101 Exclusion of Specified Activities Reuse of Parenteral Devices and Supplies GSL13424 Services to Animals GSL13425 Business Owner Coverage Extension Endorsement G-123846-D09 Florida Cancellation and Non -Renewal GSL3886 Coverage & Cap on Losses from Certified Acts Terrorism GSL3908 Notice - Offer of Terrorism Coverage & Disclosure of Premium CNA79575 Exclusion of Cosmetic Procedures OPTIONAL ENDORSEMENTS FORM # DESCRIPTION G-123828-B Certificate Holder GSL13428 DBA or Specified Endorsementns CNA79575 Exclusion of Cosmetic Procedures GSL-5587 Consulting Services Liability Endorsement PLEASE REFER TO YOUR CERTIFICATE OF INSURANCE FOR THE POLICY FORMS & ENDORSEMENTS SPECIFIC TO YOUR STATE AND YOUR POLICY PERIOD. For NJ residents: The PLIGA surcharge shown on the Certificate of Insurance is the NJ Property & Liability Insurance Guaranty Association. For KY residents: The Surcharge shown on the Certificate of Insurance is the KY Firefighters and Law Enforcement Foundation Program Fund and the KY LGPT is the KY Local Government Premium Tax which includes charges at a municipality and/or county level. For WV residents: The surcharge shown ppthe Certificate of Insurance is the WV Premium Surcharge. For FL residents: The FIGA Assessment sho*11 o� T l of Insurance is the FL Insurance Guaranty Association - 2012 Regular Assessment. Form#:G-141241-B (03/2010) ^, : �Jd Named Insured: Quantum Health Solutions, I Policy#: 0270500214 Master Policy#-.188711433 ff 1 ;.Jf �1 �?jl}6 r-� 0311'.4 AC"R" CERTIFICATE OF LIABILITY INSURANCE L DATE (MM/DD/YYYY) 12/12/2015 1. THIS CERTIFICATEIS 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 SUBROGATIONIS WAIVED, subject to the terns 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 USAA INSURANCE AGENCY INC/PHS 812846 P: (888) 242-1430 F: (888) 443-6112 PO BOX 33015 SAN ANTONIO TX 78265 CONTACT NAME: (WCC..No.Ext): (888) 242-1430 wc.Nu): (888) 443-6112 ;D �: INSURERS) AFFORDING COVERAGE NAICN INSURERA: Hartford Casualty Ins Co INSURED QUANTUM HEALTH SOLUTIONS INC 4873 PALM COAST PKWY NW UNIT 3 PALM COAST FL 32137 INSURER 8: INSURER C: INSURER D: INSURER E: INSURER F: I.VVtKAUrb trtKIIrIGAIt NUMKtK: 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. IVSR TYPE OF INSURANCE A.."'I St WR /31" POLICTNUAMER POLICYEFF POLICTEXP LLNITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s2,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) s300,000 X X MEDEXP(Any oneperson) $10, 000 A General Liab 65 SBA TF9660 12/05/2015 12/05/2016 PERSONAL 8 ADV INJURY s2,000,000 GENT AGGREGATE LIMIT APPLES PER POLICY PRO- ❑X LOC GENERAL AGGREGATE $ 4 , 0 0 0 , 0 0 0 PRODUCTS - COMPIOP AGG $ 4 , 000, 000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ HIRED AUTOS NON -OWNED AUTOS $ APPRO E UMBRELLA LIAB OCCUR D (T/L Vt �: C/", EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE WAIVE NJ/AS $�, "0/A /O ' RETENTIONS $ WORXERSCOMPENSATLON AND EMPLOTERS LIABD.IIT PER OTH- STATUTE ER E.L. EACH ACCIDENT $ ANY PROPMETOR/PARTNER/EXECUTIVEY/N OFFICERIMEMBER EXCLUDED? (Mandatory in NH) ❑ N/A F E.L. DISEASE- EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICPMRD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. Monroe County BOCC is additional insured per the business liability coverage form ss0008. V 1.3 AINAW "UNOW MONROE COUNTY BOCC 61 •£ Nd s- 83J 91OZ 1100 SIMONTON ST UdUJI� dOJ 031i-l' KEY WEST, FL 33040 �.IY17�.CLLM I IVre 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 (2014/01) The ACORD name and logo are registered marks of ACORD ed. ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 1/30/2016 THIS CERTIFICATEIS 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 SUBROGATIONIS 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 USAA INSURANCE AGENCY INC/PHS 812846 P: (888) 242-1430 F: (888) 443-6112 PO BOX 33015 SAN ANTONIO TX 78265 CONTACT NAME: A//CD.No.E.t): (888) 242-1430 ( AX.No>: (888) 443-6112 ADDRIESS: INSURER(S) AFFORDING COVERAGE NAIL# INSURERA: Hartford Casualty Ins Co INSURED QUANTUM HEALTH SOLUTIONS INC 4873 PALM COAST PKWY NW UNIT 3 PALM COAST FL 32137 wsURERB: Multiple Companies INSURER C INSURER D: 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 OFINSVRANCE ADDL SUBB POLICYNTIMBER POLICYEFF POLICYEXP LEWIS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s2,000,000 CLAIMS -MADE � OCCUR ENTED PREMISES EDAMAGE TO a occcurrence) $1, 0 0 0, 000 A General Liab 65 SEA PS3897 02/17/2016 02/17/2017 X X MED EXP (Any one person) $10, 000 PERSONAL & ADV INJURY s2,0001000 GENT AGGREGATE LIMIT APPLIES PER POLICY PROT [X]LOC JEC GENERAL AGGREGATE s4,000,000 PRODUCTS - COMP/OP AGG s4,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) s2,000,000 BODILY INJURY (Per person) g ANY AUTO BODILY INJURY (Per acciderd) $ A ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X NONINED AUTOS 65 SBA PS3897 02/17/2016 02/17/2017 PROPERTY DAMAGE (Per accident) $ g UMBRELLALIAS OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DE RETENTION $ $ WORLUSCOWFN'SA77ON AND @rPLOPERSLLaBILnT ANY PROPRIETOR/PARTNER/EXECUTIVEY/N X PER OTH- SiAME ER E.L. EACH ACCIDENT $1 , 000,000 $ OFFICERIMEMBER EXCLUDED? (Mandatory inNH) F] WA65 WEC GD3821 02/11/2016 02/11/2017 E.L. DISEASE -EA EMPLOYEE $1, QQQ, 000 E.L. DISEASE - POLICY LIMIT ' 1 0 0 0 0 0 0 ' It yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OFOPERATIONS/LOCATIONS/VEHXPMRD 101, Additional Remarks Schedule, may be attached if more space is required) addi nal Those usual to the Insured's Operations. Monroe County BOC4PR insured per the business liability coverage form ss0008. E NAGEMENT 1a .k-IN110J 30dNOW / ES— C�' �1 it, ' `] ' 811) 141.1 r=oriru-ATc uni nF:p CANCELLATION 9 i;, =8 A Z 183.E 9IOZSHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BECELLED DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 4 MO NRO E COUNTY BO C C �j �j 031 j 1100 SIMONTON ST 7k� KEY WEST, FL 33040 ©1988-2014 ACORD CORPORATION. All rights ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD -eserved.