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Item C35
C.35 t, BOARD OF COUNTY COMMISSIONERS County of Monroe Mayor Sylvia Murphy,District 5 The Florida Keys � � �l'U � Mayor Pro Tern Danny Kolhage,District 1 �pw° Michelle Coldiron,District 2 Heather Carruthers,District 3 David Rice,District 4 County Commission Meeting April 17, 2019 Agenda Item Number: C.35 Agenda Item Summary #5431 BULK ITEM: Yes DEPARTMENT: Employee Services TIME APPROXIMATE: STAFF CONTACT: Mark Gongre(305) 292-4559 no AGENDA ITEM WORDING: Approval of first amendment with Employer's Mutual Inc., Third Party Administrator for Worker's Compensation, to update the name of the Corporation. ITEM BACKGROUND: Workers' Compensation Third Party Administrator contract amendment to change the name of the corporation to Relation Insurance Services of Florida, Inc. On September 21, 2016, Monroe County, Florida entered into a Contract for Workers Compensation Third Party Claims Administration Services with Employers Mutual, Inc., a Florida for-profit corporation doing business as Ascension Benefits & Insurance Solutions. The current contract extends through September 20, 2019, with the possible of automatic renewals until September 20, 2021. On October 12, 2017, Employers Mutual, Inc. filed an amendment to its Articles of Incorporation with the Florida Secretary of State, amending the name of the corporation to Relation Insurance Services of Florida, Inc. with no change to the federal employer's identification number. The purpose of this contract amendment is to update the name of the corporation. No other changes to the contract terms are included in this amendment. PREVIOUS RELEVANT BOCC ACTION: September 21, 2016 - Contract for Workers Compensation Third Party Claims Administration Services with Employers Mutual, Inc. doing business as Ascension Benefits and Insurance Solutions. CONTRACT/AGREEMENT CHANGES: Changes name of the Corporation STAFF RECOMMENDATION: Approval. DOCUMENTATION: Relation Florida- Monroe County First Amendment to Claims Admin Servs Agreement Final (2) 09212016 Contract EMI Packet Pg. 1212 C.35 FINANCIAL IMPACT: Effective Date: April 17, 2019 Expiration Date: n/a Total Dollar Value of Contract: Approx. $74,000/year x 5 years. This is a no-cost amendment; no change to dollar value of contract as a result of the amendment. Total Cost to County: Current Year Portion: Budgeted: Source of Funds: CPI: Indirect Costs: Estimated Ongoing Costs Not Included in above dollar amounts: Revenue Producing: If yes, amount: Grant: County Match: Insurance Required: Additional Details: none REVIEWED BY: Bryan Cook Completed 04/01/2019 5:35 PM Assistant County Administrator Christine Hurley Completed 04/02/2019 7:43 AM Cynthia Hall Completed 04/02/2019 8:44 AM Budget and Finance Completed 04/02/2019 9:52 AM Maria Slavik Completed 04/02/2019 9:54 AM Kathy Peters Completed 04/02/2019 12:26 PM Board of County Commissioners Pending 04/17/2019 9:00 AM Packet Pg. 1213 C.35.a FIRST AMENDMENT TO IL CONTRACT FOR WORKERS COMPENSATION THIRD PARTY CLAIMS ADMINISTRATION SERVICES BY AND BETWEEN MONROE COUNTY, FLORIDA,AND EMPLOYER'S MUTUAL,INC.DIBIA ASCENSION BENEFITS& INSURANCE SOLUTIONS �s THIS First Amendment ("First Amendment") is made to be effective the day of May 2019 ("Effective Date"), by and between Relation Insurance Services of Florida, Inc. 3 ("Relation"), formerly known as Employers Mutual, Inc. dlbla Ascension Benefits & Insurance Solutions, and Monroe County, Florida("County"). WHEREAS, on September 21, 2016, Monroe County, Florida entered into a Contract for Workers Compensation Third Party Claims Administration Services with Employers Mutual, Inc., a Florida for-profit corporation doing business as Ascension Benefits & Insurance Solutions; and U) WHEREAS,the Contract remains in effect until September 20, 2019, with the possible of automatic renewals until September 20, 2021; and WHEREAS, on October 12, 2017, Employers Mutual, Inc. filed an amendment to its Articles of Incorporation with the Florida Secretary of State, amending the name of the E corporation to Relation Insurance Services of Florida, Inc, with no change to the federal employer's identification number; and WHEREAS, on December 5, 2017, Employers Mutual, Inc. cancelled its registration of the fictitious business name "Ascension Benefits & Insurance Solutions" with the Florida Secretary of State; and E WHEREAS, the parties now desire to amend the Contract to reflect the correct current name of the vendor. NOW, THEREFORE, in consideration of the mutual covenants and conditions set forth below, Assignor and Assignee agree as follows: 0 1. The name of the Contractor is changed in the Contract from Employers Mutual, e Inc. dlbla Ascension Benefits & Insurance Solutions to Relation Insurance Services of Florida, Inc.,wherever it appears in the Contract. 2. In all other respects the terms and conditions of the Contract remain in full force and effect. 3. This First Amendment may be executed in multiple counterparts, each of which shall be deemed an original and which together shall constitute one and the same instrument. In accordance with Monroe County Ordinance No. 005-2018, this document may be signed using 1 Packet Pg. 1214 an electronic or digital signature. 4. E'ach signatory to this Amendment represents that lie possesses the requisite corporate authority to bind his respective entity. U) CL E IN WITNESS WHEREOF, each party has caused this First Amendment to be duly 0 executed and effective as of the date above written. Witness: Relation Insurance Services of Florida, Inc. 0 C14 Print an e: "ji-tj Q�P'LA- 5 006 3 Edward Nathan Page, President U- Date: E Attest: Kevin Madok,CPA,Clerk Monroe County, Florida U) it By: By: Deputy Clerk Sylvia J. Murphy, Mayor E Date: U) E 0 E E U- 0 U 0 0 0 U- E 2 Packet Pg. 1215 C.35.b AMY REAVIIIN, CPA CLERK OF CIRCUIT COURT & COMPTROLLER MONROE COUNTY,FLORIDA DATE. November 28, 2016 Z TO: Maria Fernandez-Gonzalez, CHRP 0 Benefits Administrator/HIPAA Privacy Officer 0 �s ATTN. MeriDe Mercado WIC Administrator a FROM: Cheryl Robertson Executive Aide to the Clerk of Court & Comptroller C E At the September 21, 2016 Board of County Commissioner's meeting the Board granted approval and authorized execution of Item C 1 Approval of a three year contract with two one year renewals with Employers Mutual, Inc. to Provide Third Party Claims Administration for the Monroe County Workers' a. Compensation Program at the annual cost of$73,500 for a total cost of$367,500 over five years. U) CL �s U) 0 Enclosed is a duplicate original of the above-mentioned for your handling. Should you have any questions,please feel free to contact our office. 0 �s cv cv CC.' County Attorney Finance File ✓ 500 Whitehead Street Suite 101,PO Box 1980,Key West,FL 33040 Phone:305-295-3130 Fax:305-295-3663 3117 Overseas Highway,Marathon,FL 33050 Phone:305-289-6027 Fax:305-289-6025 88820 Overseas Highway,Plantation Key,FL 33070 Phone:852-7145 Fax 305-852-7146 Packet Pg. 1216 MONROE COUNTY CONTRACT FOR Workers Compensation Third Party Claims Administration Services THIS AGREEMENT is made and entered into this day of ' 2016, by MONROE County ("County"), a political subdivision of the State of F orida, whose address is 1100 Simonton Street, Key West, Florida 33040 and Employer's Mutual, Inc. d/b/a/Ascension Benefits & Insurance Solutions ("Contractor" or"TPA"), whose address is 700 Central Parkway, Stuart, FL 34994. Z Section 1. SCOPE OF SERVICES 0 0. Contractor shall do, perform and carry out in a professional and proper manner certain duties as described in the Scope of Services—Exhibit A—which is attached hereto and made a part of this agreement. Contractor shall provide the scope of services in Exhibit A for County. Contractor warrants that it is authorized by law to engage in the performance of the activities herein described, subject to the terms and conditions set forth in these Agreement documents. The Contractor shall at all times exercise independent, professional judgment and shall assume professional responsibility for the services to be provided. Contractor shall provide services using the following standards, E as a minimum requirement: A. The Contractor shall maintain adequate staffing levels to provide the services required under the Agreement resulting from this RFP process. B. The personnel shall not be employees of or have any contractual relationship with the County. To the extent that Contractor uses subcontractors or o independent contractors, this Agreement specifically requires that subcontractors and independent contractors shall not be an employee of or have any contractual relationship with County. C. All personnel engaged in performing services under this Agreement shall be fully 0 qualified, and, if required, to be authorized or permitted under State and local law to perform such services. Section 2. COUNTY'S RESPONSIBILITIES o 2.1 Provide all best available information as to the County's requirements for the scope of services described in Exhibit A to this Agreement. 2.2 Designate in writing a person with authority to act on the County's behalf on all matters concerning said services. 2.3 Provide a schedule that is mutually agreeable to the County and Contractor. Section 3. TERM OF AGREEMENT v 3.1 The terms of this Agreement shall be from the effective date hereof and continue for a E period of three years. This Agreement shall be automatically renewed twice for succes- sive one-year periods unless either party gives the other notice of cancellation in accordance with the terms set forth below. The Contractor must provide at least ninety (90) days' notice of intent to terminate. The County must provide the Contractor with at least ninety (90) days' notice of intent to terminate. If either party desires to modify this Page 1 of 21 Packet Pg. 1217 C.35.b Agreement, it shall notify the other in writing at least thirty (30) days prior to the effective date of such modification. In the case of proposed modification the party receiving the notification of the proposed modification shall itself notify the other party within ten (10) days after receipt of notice of its agreement to the proposed modification. Failure to do so shall terminate this Agreement. Section 4. COMPENSATION U 0 Base compensation to Contractor shall be seventy-three thousand five hundred dollars and no z cents ($73,500) annually, paid in twelve (12) monthly equal installments. 0 Medical Bill re-pricing services provided in accordance with the state's allowable cost are0. inclusive of the annual fee. U Medical Bill reductions beyond the state's allowable cost will be provided at twenty-five percent (25%) of savings: Network access: cost to reduce fees to TPA's own network: 25% of savings Subrogation and Second Injury Fund activities will be provided at 25% of recovered funds. In addition, the County will pay for the following items paid to outside firms provided they are U approved in advance by the Administrator: private investigators/surveillance, witness fees, legal or court reporters, cost of Medicare Set Aside (MSA) preparation. 0 U) Section 5. PAYMENT TO CONTRACTOR 5.1 Payment will be made according to the Florida Local Government Prompt Payment Act. c U Any request for payment must be in a form satisfactory to the Clerk of Courts for Monroe County (Clerk). The request must describe in detail the services performed and the 0 payment amount requested. The Contractor must submit invoices to the appropriate offices marked Monroe County Workers' Compensation Office, Employee Services Department, 1100 Simonton St., Key West, FL 33040. The respective office supervisor and the Director of Employee Services will review the request, note his/her approval on the request and forward it to the Clerk for payment. 5.2 Continuation of this Agreement is contingent upon annual appropriation by Monroe County. U Section 6. CONTRACT TERMINATION cv Either party may terminate this Agreement because of the failure of the other party to perform its obligations under the Agreement. County may terminate this Agreement with or without cause upon ninety (90) days' written notice to the Contractor. Contractor may terminate this Agreement with or without cause upon ninety (90) days' written notice to County. County shall pay Contractor for work performed through the date of termination. Section 7. CONTRACTOR'S ACCEPTANCE OF CONDITIONS Page 2 of 21 Packet Pg. 1218 C.35.b A. Contractor hereby agrees that it has carefully examined the RFP, its response, and this Agreement and has made a determination that it has the personnel, equipment, and other requirements suitable to perform this work and assumes full responsibility therefore. The provisions of the Agreement shall control any inconsistent provisions contained in the specifications. All specifications have been read and carefully considered by Contractor, who understands the same and agrees to their sufficiency for the work to be done. Under no circumstances, conditions, or situations shall this U Agreement be more strongly construed against County than against Contractor. 0 B. Any ambiguity or uncertainty in the specifications shall be reasonably interpreted and 0 construed by County, and its decision shall be final and binding upon all parties; 0 provided that the decision is commercially reasonable. 2 C. The passing, approval, and/or acceptance by County of any of the services furnished by Contractor shall not operate as a waiver by County of strict compliance with the terms of this Agreement and specifications covering the services. D. Contractor agrees that County Administrator or its designated representatives may visit Contractor's facility (ies) periodically to conduct random evaluations of services during Contractor's normal business hours. E. Contractor has, and shall maintain throughout the term of this Agreement, appropriate licenses and approvals required to conduct its business, and that it will at all times conduct its business activities in a reputable manner. Proof of such licenses and approvals shall be submitted to County upon request. Section 8. NOTICES U Any notice required or permitted under this agreement shall be in writing and hand delivered or mailed, postage prepaid, to the other party by certified mail, returned receipt requested, to the following: To the County: Ms. Meri-De Mercado, Administrator, Office of Workers' Compensation 1100 Simonton Street, Suite 2-268 0 Key West, Florida 33040 U U) 0 To the Contractor: Employers Mutual, Inc. 0 Attn: President 700 Central Parkway, Stuart, FL 34994 Section 9. RECORDS Contractor shall maintain all books, records, and documents directly pertinent to performance under this Agreement in accordance with generally accepted accounting principles consistently applied. Each party to this Agreement or their authorized representatives shall have reasonable and timely access to such records of each other party to this Agreement for public records purposes during the term of the agreement and for five years following the termination of this Agreement. If an auditor employed by the County or Clerk determines that monies paid to Contractor pursuant to this Agreement were spent for purposes not authorized by this 0 Agreement, the Contractor shall repay the monies together with interest calculated pursuant to 0 Section 55.03 of the Florida Statutes, running from the date the monies were paid to Contractor. Pursuant to F.S. 119.0701, Contractor and its subcontractors shall comply with all public records laws of the State of Florida, including but not limited to: Page 3 of 21 Packet Pg. 1219 a. Keep and maintain public records required by Monroe County in order to perform the service. b. Upon request from the public agency's custodian of public records, provide the public agency with a copy of the requested records or allow the records to be inspected or copied within a reasonable time at a cost that does not exceed the cost provided in Florida Statutes, Chapter 119 or as otherwise provided by law. M c. Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law for the duration of the contract term and following completion of the contract if the contractor does not transfer the records to the public agency. �s d. Upon completion of the contract, transfer, at no cost, to Monroe County all public records in possession of the contractor or keep and maintain public records required by the public agency to perform the service. If the contractor transfers all public records to the public agency upon completion of the contract, the contractor shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. If the contractor keeps and maintains public records upon completion of the contract, the contractor shall meet all applicable requirements for retaining public records. All records stored electronically must be provided to Monroe County, upon request from the public agency's custodian of records, in a format that is compatible with the information technology systems of �s Monroe County. IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE U) CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS, BRIAN BRADLEY, AT (305) 292-3470, Bradley_ brian(a�monroecounty-fl.gov, c/o Monroe County Attorney's Office, 1111 12 h St., Suite 408, Key West FL 33040. Section 10. EMPLOYEES SUBJECT TO COUNTY ORDINANCE NO. 010-1990 c� The Contractor warrants that it has not employed, retained or otherwise had act on its behalf any former County officer or employee subject to the prohibition of Section 2 of Ordinance No. �s 010-1990 or any County officer or employee in violation of Section 3 of Ordinance No. 010- 1990. For breach or violation of this provision the County may, in its discretion, terminate this agreement without liability and may also, in its discretion, deduct from the agreement or purchase price, or otherwise recover the full amount of any fee, commission, percentage, gift, or consideration paid to the former County officer or employee. c� Page 4 of 21 Packet Pg. 1220 • C.35.b Section 11. CONVICTED VENDOR A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid on an Agreement with a public entity for the construction or repair of a public building or public work, may not perform work as a Contractor, supplier, subcontractor, or Contractor under Agreement with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section U 287.017 of the Florida Statutes, for the Category Two for a period of 36 months from the date of 0 being placed on the convicted vendor list. z Section 12. GOVERNING LAW, VENUE, INTERPRETATION, COSTS AND FEES g This Agreement shall be governed by and construed in accordance with the laws of the State of c Florida applicable to Agreements made and to be performed entirely in the State. 0 In the event that any cause of action or administrative proceeding is instituted for the enforcement or interpretation of this Agreement, the County and Contractor agree that venue shall lie in the appropriate court or before the appropriate administrative body in Monroe County, Florida. Section 13. SEVERABILITY If any term, covenant, condition or provision of this Agreement (or the application thereof to any circumstance or person) shall be declared invalid or unenforceable to any extent by a court of competent jurisdiction, the remaining terms, covenants, conditions and provisions of this Agreement, shall not be affected thereby; and each remaining term, covenant, condition and provision of this Agreement shall be valid and shall be enforceable to the fullest extent permitted by law unless the enforcement of the remaining terms, covenants, conditions and provisions of this Agreement would prevent the accomplishment of the original intent of this Agreement. The County and Contractor agree to reform the Agreement to replace any stricken provision with a c valid provision that comes as close as possible to the intent of the stricken provision. U U) Section 14. ATTORNEYS FEES AND COSTS 0 The County and Contractor agree that in the event any cause of action or administrative proceeding is initiated or defended by any party relative to the enforcement or interpretation of this Agreement, the prevailing party shall be entitled to reasonable attorney's fees, and court costs, as an award against the non-prevailing party. Mediation proceedings initiated and conducted pursuant to this Agreement shall be in accordance with the Florida Rules of Civil Procedure and usual and customary procedures required by the Circuit Court of Monroe c �s County. Section 15. BINDING EFFECT The terms, covenants, conditions, and provisions of this Agreement shall bind and inure to the benefit of the County and Contractor and their respective legal representatives, successors, and 0 assigns. Section 16. AUTHORITY Each party represents and warrants to the other that the execution, delivery and performance of Page 5 of 21 Packet Pg. 1221 • C.35.b this Agreement have been duly authorized by all necessary County and corporate action, as required by law. Section 17. ADJUDICATION OF DISPUTES OR DISAGREEMENTS County and Contractor agree that all disputes and disagreements shall be attempted to be resolved by meet and confer sessions between representatives of each of the parties. If no resolution can be agreed upon within 30 days after the first meet and confer session, then any E party shall have the right to seek such relief or remedy as may be provided by this Agreement or by Florida law. This Agreement shall not be subject to arbitration. Section 18. COOPERATION 0 In the event any administrative or legal proceeding is instituted against either party relating to the formation, execution, performance, or breach of this Agreement, County and Contractor agree to participate, to the extent required by the other party, in all proceedings, hearings, processes, meetings, and other activities related to the substance of this Agreement or provision of the services under this Agreement. County and Contractor specifically agree that no parry to this Agreement shall be required to enter into any arbitration proceedings related to this Agreement. Section 19. NONDISCRIMINATION The parties agree that there will be no discrimination against any person, and it is expressly understood that upon a determination by a court of competent jurisdiction that discrimination has occurred, this Agreement automatically terminates without any further action on the part of c any party, effective the date of the court order. The parties agree to comply with all Federal and U) Florida statutes, and all local ordinances, as applicable, relating to nondiscrimination. These include but are not limited to: 1) Title VI I of the Civil Rights Act of 1964 (PL 88-352), which prohibit discrimination in employment on the basis of race, color, religion, sex, and national c origin; 2) Title IX of the Education Amendment of 1972, as amended (20 USC §§ 1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; 3) Section 504 of the Rehabilitation Act of 1973, as amended (20 USC § 794), which prohibits discrimination on the basis of handicaps; 4) The Age Discrimination Act of 1975, as amended (42 USC §§ 6101- 6107), which prohibits discrimination on the basis of age; 5) The Drug Abuse Office and Treatment Act of 1972 (PL 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; 6) The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (PL 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; 7) The Public Health Service Act of 1912, §§ 523 and 527 (42 USC §§ 690dd-3 and 290ee-3), as amended, relating to confidentiality of alcohol and drug abuse patent records; 8) Title Vill of the Civil Rights Act of 1968 (42 USC §§ 3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; 9) The Americans with Disabilities Act of 1990 (42 USC §§ 1201), as amended from time to time, relating to nondiscrimination in employment on the basis of disability; 10) Monroe County Code Chapter 13, Article VI, which prohibits discrimination on the basis of race, color, sex, religion, national origin, ancestry, sexual orientation, gender identity or expression, familial status or age; and 11) any other nondiscrimination provisions in any federal or state statutes which may apply to the parties to, or the subject matter of, this Agreement. Section 20. COVENANT OF NO INTEREST Page 6 of 21 Packet Pg. 1222 County and Contractor covenant that neither presently has any interest, and shall not acquire any interest, which would conflict in any manner or degree with its performance under this Agreement, and that only interest of each is to perform and receive benefits as recited in this Agreement. Section 21. CODE OF ETHICS County agrees that officers and employees of the County recognize and will be required to Z comply with the standards of conduct for public officers and employees as delineated in Section 112.313, Florida Statutes, regarding, but not limited to, solicitation or acceptance of gifts; doing business with one's agency; unauthorized compensation; misuse of public position, conflicting o employment or contractual relationship; and disclosure or use of certain information. Section 22. NO SOLICITATION/PAYMENT The County and Contractor warrant that, in respect to itself, it has neither employed nor retained any company or person, other than a bona fide employee working solely for it, to solicit or secure this Agreement and that it has not paid or agreed to pay any person, company, corporation, individual, or firm, other than a bona fide employee working solely for it, any fee, commission, percentage, gift, or other consideration contingent upon or resulting from the award or making of this Agreement. For the breach or violation of the provision, the Contractor agrees that the County shall have the right to terminate this Agreement without liability and, at its discretion, to offset from monies owed, or otherwise recover, the full amount of such fee, a. commission, percentage, gift, or consideration. Section 23. PUBLIC ACCESS U) The County and Contractor shall allow and permit reasonable access to, and inspection of, all documents, papers, letters or other materials in its possession or under its control subject to the provisions of Chapter 119, Florida Statutes, and made or received by the County and Contractor in conjunction with this Agreement; and the County shall have the right to unilaterally cancel this 0 Agreement upon violation of this provision by Contractor. Section 24. NON-WAIVER OF IMMUNITY Notwithstanding the provisions of Sec. 768.28, Florida Statutes, the participation of the County and the Contractor in this Agreement and the acquisition of any commercial liability insurance coverage, self-insurance coverage, or local government liability insurance pool coverage shall not be deemed a waiver of immunity to the extent of liability coverage, nor shall any Agreement entered into by the County be required to contain any provision for waiver. cv Section 25. PRIVILEGES AND IMMUNITIES All of the privileges and immunities from liability, exemptions from laws, ordinances, and rules and pensions and relief, disability, workers' compensation, and other benefits which apply to the activity of officers, agents, or employees of any public agents or employees of the County, when performing their respective functions under this Agreement within the territorial limits of the County shall apply to the same degree and extent to the performance of such functions and duties of such officers, agents, volunteers, or employees outside the territorial limits of the County. Page 7 of 21 Packet Pg. 1223 Section 26. LEGAL OBLIGATIONS AND RESPONSIBILITIES Non-Delegation of Constitutional or Statutory Duties. This Agreement is not intended to, nor shall it be construed as, relieving any participating entity from any obligation or responsibility imposed upon the entity by law except to the extent of actual and timely performance thereof by any participating entity, in which case the performance may be offered in satisfaction of the obligation or responsibility. Further, this Agreement is not intended to, nor shall it be construed E as, authorizing the delegation of the constitutional or statutory duties of the County, except to Z the extent permitted by the Florida constitution, state statute, and case law. Section 27. NON-RELIANCE BY NON-PARTIES No person or entity shall be entitled to rely upon the terms, or any of them, of this Agreement to enforce or attempt to enforce any third-party claim or entitlement to or benefit of any service or program contemplated hereunder, and the County and the Contractor agree that neither the County nor the Contractor or any agent, officer, or employee of either shall have the authority to inform, counsel, or otherwise indicate that any particular individual or group of individuals, entity or entities, have entitlements or benefits under this Agreement separate and apart, inferior to, or superior to the community in general or for the purposes contemplated in this Agreement. c� Section 28. ATTESTATIONS 0 �s Contractor agrees to execute such documents as the County may reasonably require, including, but not being limited to, a Public Entity Crime Statement, an Ethics Statement, and a Drug-Free Workplace Statement, Lobbying and Conflict of Interest Clause, and Non-Collusion Agreement. Section 29. NO PERSONAL LIABILITY No covenant or agreement contained herein shall be deemed to be a covenant or agreement of o any member, officer, agent or employee of Monroe County in his or her individual capacity, and U no member, officer, agent or employee of Monroe County shall be liable personally on this Agreement or be subject to any personal liability or accountability by reason of the execution of this Agreement. o Section 30. EXECUTION IN COUNTERPARTS This Agreement may be executed in any number of counterparts, each of which shall be regarded as an original, all of which taken together shall constitute one and the same instrument and any of the parties hereto may execute this Agreement by signing any such counterpart. Section 31. SECTION HEADINGS cv Section headings have been inserted in this Agreement as a matter of convenience of reference only, and it is agreed that such section headings are not a part of this Agreement and will not be used in the interpretation of any provision of this Agreement. c� Section 32. INSURANCE POLICIES 32.1 General Insurance Requirements for Other Contractors and Subcontractors. As a pre-requisite of the work governed, the Contractor shall obtain, at his/her own expense, Page 8 of 21 Packet Pg. 1224 insurance as specified in any attached schedules, which are made part of this contract. The Contractor will ensure that the insurance obtained will extend protection to all Subcontractors engaged by the Contractor. As an alternative, the Contractor may require all Subcontractors to obtain insurance consistent with the attached schedules; however Contractor is solely responsible to ensure that said insurance is obtained and shall submit proof of insurance to County. Failure to provide proof of insurance shall be grounds for termination of this Agreement. The Contractor will not be permitted to commence work governed by this contract until E satisfactory evidence of the required insurance has been furnished to the County as specified z below. Delays in the commencement of work, resulting from the failure of the Contractor to provide satisfactory evidence of the required insurance, shall not extend deadlines specified in this contract and any penalties and failure to perform assessments shall be imposed as if the work commenced on the specified date and time, except for the Contractor's failure to provide0. satisfactory evidence. The Contractor shall maintain the required insurance throughout the entire term of this contract and any extensions specified in the attached schedules. Failure to comply with this provision may result in the immediate suspension of all work until the required insurance has been reinstated or replaced and/or termination of this Agreement and for damages to the County. Delays in the completion of work resulting from the failure of the Contractor to maintain the required insurance shall not extend deadlines specified in this contract and any penalties and failure to perform assessments shall be imposed as if the work had not been suspended, except for the Contractor's failure to maintain the required insurance. The required insurances are: U Type of Insurance Limits Workers' Compensation Statutory Employers' Liability $500,000 General Liability $1 million Vehicle Liability $1 million Professional Liability $1 million 0 The Contractor shall provide, to the County, as satisfactory evidence of the required insurance, either: 0 • Certificate of Insurance or • A Certified copy of the actual insurance policy. 0 The County, at its sole option, has the right to request a certified copy of any or all insurance policies required by this contract. All insurance policies must specify that they are not subject to cancellation, non-renewal, material change, or reduction in coverage unless a minimum of thirty (30) days prior notification is given to the Contractor by the insurer. In the event the Contractor receives any such notice from an insurer, the Contractor shall immediately provide the County with notice of the same. c� The acceptance and/or approval of the Contractor's insurance shall not be construed as relieving the Contractor from any liability or obligation assumed under this contract or imposed by law. Page 9 of 21 Packet Pg. 1225 Monroe County Board of County Commissioners, its employees and officials will be included as "Additional Insured" on all policies, except for Workers' Compensation and Professional Liability (including Employers' Liability). Section 33. INDEMNIFICATION The Contractor does hereby consent and agree to indemnify and hold harmless the County, its E Mayor, the Board of County Commissioners, appointed Boards and Commissions, Officers, and the Employees, and any other agents, individually and collectively, from all fines, suits, claims, demands, actions, costs, obligations, attorneys' fees, or liability of any kind arising out of the sole negligent actions of the Contractor or substantial and unnecessary delay caused by the o willful nonperformance of the Contractor and shall be solely responsible and answerable for any and all accidents or injuries to persons or property arising out of its performance of this contract. U The amount and type of insurance coverage requirements set forth hereunder shall in no way be construed as limiting the scope of indemnity set forth in this paragraph. Further the Contractor agrees to defend and pay all legal costs attendant to acts attributable to the sole negligent act of the Contractor. At all times and for all purposes hereunder, the Contractor is an independent contractor and not an employee of the Board of County Commissioners. No statement contained in this agreement shall be construed so as to find the Contractor or any of his/her employees, contractors, servants or agents to be employees of the Board of County Commissioners for Monroe County. U As an independent contractor the Contractor shall provide independent, professional judgment a. and comply with all federal, state, and local statutes, ordinances, rules and regulations applicable to the services to be provided. o The Contractor shall be responsible for the completeness and accuracy of its work, plan, a supporting data, and other documents prepared or compiled under its obligation for this project, 0. and shall correct at its expense all significant errors or omissions therein which may be o disclosed. The cost of the work necessary to correct those errors attributable to the Contractor and any damage incurred by the County as a result of additional costs caused by such errors shall be chargeable to the Contractor. This provision shall not apply to any maps, official records, contracts, or other data that may be provided by the County or other public or semi- public agencies. The Contractor agrees that no charges or claims for damages shall be made by it for any delays or hindrances attributable to the County during the progress of any portion of the services specified in this contract. Such delays or hindrances, if any, shall be compensated for by the County by an extension of time for a reasonable period for the Contractor to complete the work schedule. Such an agreement shall be made between the parties. N Ir- [The rest of this page intentionally left blank.] c� Page 10 of 21 Packet Pg. 1226 C.35.b IN rITNESS W REOF, the parties hereto have caused these presents to be executed on the day of 2016. (S L) MONROE COUNTY BOARD OF County COMMISSIONERS �s HEAVILIN, CLERK E OUNTY, FLORIDA z y 5 &Deputy Clerk Mayor/Gheim-art ro ja-) 0 0 (CORPORATE SEAL) Employer's Mutual, Inc. d/b/a Ascension Benefits& Insurance Solutions ATTEST:By B Corporate Counsel Title: Chief Financial and Operating Officer 0 �s 0 U) 0 �s U) 0 C-• .A u) c t,= o ^i CO J V Lt_ i� N MONROE COUNTY O TORNE AP rOVE NTHIA L. HALL ASSISTA T COUNT\t ATTORNEY D Date Page 11 of 21 Packet Pg. 1227 Exhibit A Scope of Services The Third Party Administrator(TPA) will provide Monroe County Board of County Commissioners (County) with an integrated claims system designed to mitigate claim cost to include aggressive claims management, safety engineering, and data analytics. Aggressive �s claims management will include sound medical and disability management and rehabilitation practices together with a robust return-to-work program while being mindful of possible fraud. M Minimum expectations include initial contact with claimant within 24 hours; recorded statements g of the claimant; contact with the treating physician within 24 hours; narrative summaries on major claims every 3 months; notification of all potential excess claims to insurer(s); and medical bill re-pricing services provided in accordance with the state's allowable cost are inclusive of the annual fee. Medical Bill reductions beyond the state's allowable cost will be provided at 25% of savings. Subrogation and Second Injury Fund activities will be provided at 25% of recovered funds. Data Analytics will provide preparation of all State mandated reports, monthly loss reports to the County and the County's consultant, and provide internet access 365 days, 24 hours a day to the computerized claims management software program utilized by the TPA to manage County claims except upon timely notice of routine maintenance and or the occasional malfunction. The County shall have access to view the financial aspects of individual claims and to review adjusters claim notes. The County shall have access to view supporting documents for all claim expenditures and generate relative reports. Access shall be provided for two County registered users at no cost. The TPA shall provide effective user trainer in Key West at no cost and continue to provide training for each new user and or when necessitated by TPA upgrades or new software programs. The TPA shall provide a user manual published by the software 0 provider to the County and shall be held responsible for timely updating the user manual when U changes are made. The TPA will provide Safety engineering and provide management consulting services to reduce the frequency and severity of claims in an effort to reduce the overall exposure. The TPA shall pay any and all fines and penalties imposed by the State that are caused by the TPA and the County shall pay any and all fines and penalties imposed by the State that are caused by the County. The TPA and County shall conduct quarterly claim review meetings, two of which are to be face- to-face with one at the office of the TPA and one at the County offices. Travel cost are to be provided by the traveling party. Two of the quarterly meetings are to be held telephonically. The County strongly believes that the number of claims assigned to individual adjusters will have a direct impact on the quality of claims management. Furthermore, the County also recognizes the importance of staff continuity in the quality of claims management. Therefore, the TPA shall provide staff to adequately manage County claims. Minimally, one Lost Time Page 12 of 21 Packet Pg. 1228 Adjuster and one Medical only adjuster shall be assigned to County claims. All claims assigned, not just County claims, to the Lost Time adjuster shall not exceed 125 and all claims, not just County claims, assigned to the Medical Only adjuster shall not exceed 250 . Lost time claims are defined as any claim that involves the payment of Compensation benefits governed by Florida Statute 440.12. Medical only claims are defined as claims where the claimant is not entitled to Compensation benefits governed by Florida Statute 440.12. County shall be notified U immediately of any changes for any reason to the staff assigned to County claims. Said E notification shall include the TPA's plans to manage the County caseload and the name of the Z new adjuster, the new adjuster's qualifications and the approach the new adjuster will take in becoming familiar with the County claims. 0 Likewise, County requires notification of any changes to outside vendors that are associated with the County claims. In that continuity of care is essential to the cost and quality of claims management, County prefers field case management services to be provided by Seltzer Associates who have developed a business relationship with County. Consideration will be provided by County at the recommendation of the TPA to change outside vendors when it is deemed in the best interest of County. The County has stringent protocols that must be followed when hiring outside legal services. While the County will consider TPA recommendations for the hiring of defense counsel, the County will have to select and contract directly with the legal firm. In addition, the County will have to directly pay the legal firm's bills. The TPA will be notified when such payments are made and the TPA will be responsible for capturing these costs in the appropriate claim. The County has issued Monroe County Administrative Instruction 7400.4 (Workers' Compensation Third Party Administrator(TPA) Direct Payment System). A copy of the Administrative Instruction is included as an attachment to this agreement. The TPA herein agrees to abide by the provisions of this Administrative Instruction. U U) 0 0 cv c� Page 13 of 21 Packet Pg. 1229 ATTACHMENT Monroe County Administrative Instruction 7400.4 z g Workers' Compensation Third Party Administrator(TPA) Direct Payment System 0 CL — 0 ca [The rest of this page intentionally left blank.] IL U) 0 U) 0 c� 0 c� Page 14 of 21 Packet Pg. 1230 BOARD OF COUNTY County of Monroe COMMISSIONERS Mayor Danny L.Kolhage,District I Mayor Pro Tern Heather Carruthers, E The Florida.Keys District 3 George Neugent,District 2 David Rice,District 4 Sylvia J.Murphy,District 5 0 0 OFFICE OF THE COUNTY ADMINISTRATOR Key West, Florida MONROE COUNTY ADMINISTRATIVE INSTRUCTION 7400.4 0 �s Date: October 16, 2015 Subject: Workers' Compensation Third Party Administrator (TPA) Direct Payment System Reference: Monroe County Projected Claim Payment System Attachments: (A.) Audit Reports (B.) Payment Authorization Form Effective Date: Immediately 0 U (1.) Purpose: In an effort to expedite the payment process of the Workers' Compensation Program, Monroe County has approved a direct claim payment system. This system will allow payments for services provided for workers' compensation to be directly mailed from the office of the TPA to the service provider in accordance with Florida Statutes. (2.) Background: On 04/17/1996, the Monroe County Board of County Commissioners approved the creation of an Escrow Banking Account Page 15 of 21 Packet Pg. 1231 and delegated limited payment authorization to the TPA for the processing of payment for the Workers' Compensation Program. (3.) Rule of Governing Direct Payment Process for Claims: a. The County will establish an Escrow Account in a bank of its choice for use by the TPA for claims payments. M b. The Workers' Compensation Third Party Administrator (TPA) will email a copy of the payment register to the Workers' Compensation Office every Wednesday and Friday. Upon receipt, the Workers' Compensation (WC)Administrator or designee will �s review the register and then notify the Finance Department's Staff Accountant via e-mail to deposit sufficient funds as needed to meet E the claims payment processed. c. The Staff Accountant will notify the TPA and the Workers' Compensation Administrator or designee via e-mail that funding is complete and will record the deposit into the financial accounting system. The TPA will not issue checks or drafts until it U receives confirmation from the County that there are sufficient funds available in the account. d. The TPA will have signatory privileges on the account up to $5,000 requiring the signatures of two supervisory personnel of the TPA. e. Checks over $55000 are sent from the TPA to the Workers' U Compensation Administrator for processing. Upon receipt of the 19 checks, the Workers' Compensation Administrator or designee with the appropriate signature authority will complete the payment authorization form (Attachment B), attach a copy of the check(s) and file it with the correlating register in the Workers' Compensation office. The check is then immediately mailed out to the appropriate party. 0 f. The TPA's payment authority is limited to the payment of satisfactorily proven claims for medical expenses and indemnity (wage loss)paid in accordance with the Florida Workers' Compensation Statute then applicable. In addition, the TPA is authorized to pay certain expenses of claims administration including medical case management, investigation expenses, transportation, and the costs of obtaining medical records and reports. Page 16 of 21 Packet Pg. 1232 C.35.b g. All other expenses, particularly legal defense costs and any payments issued to the TPA or related entity will be paid by the County directly in accordance with the County's accounts payable procedures. h. Within five (5) days of receipt of the payment register (from the TPA), the Workers' Compensation office will provide the Staff Accountant a signed certified register which affirms that the Z Workers' Compensation Administrator has reviewed the register and that the payments are being made for persons covered under the Monroe County Workers' Compensation Program. The certification will detail which line items are to be debited in the workers' compensation fund. i. Should a void or stop payment request on a check that has been E issued be required, the Finance Department's Administrative Assistant will gather and prepare the required documentation and present it to the Finance Department's authorized BANK SIGNER. Once the transaction has been voided or the stop payment request is processed, the Administrative Assistant will notify the appropriate parties (TPA, and WC Administrator). j. The Workers' Compensation Office will audit the TPA claims handling procedures and payments on a continuous basis. The actual claim files administered by the TPA will be audited no less than once a year. The Workers' Compensation Office will review U the reports (Attachment A) on all open Workers' Compensation 19 files provided at each audit by the TPA and provide a written report to the Department Head outlining audit findings upon request. Distribution: List IV 0 0 Originator: TEA cv cv 0 Page 17 of 21 Packet Pg. 1233 C.35.b c m g y E O 0. - U O w E « U y E 7 � U � C � H N E IL M V V a c c g m � OCL c c 3 v N �g m � Q E O U Y O O Z N c$ Eco E U O U o Z. �+ CD 3 C O 0 U O E m a c O U O Z `c E O 2 Packet Pg. 1234 . � U m $ � \ E o d 0 U E � \ / & m \ m 2 � « $ @ 0 1CA U E IL � 2 � a g O CL e _ P § 2 / n � � m E m ° J 2 � ` L E \ g o§ \ / . � a � / U � o f /� ■ � . k � � m 2 � J U � E § z § © 2 Packet Pg. 1235 C.35.b U m CL 0 0 IL c O U N V c f) 0 N C CL DI N 0 U N CO) !6 U 0 U � � 0 L CC U G 0 Cd T Cd CD C38 E t6 Z 0 4� d C E Packet Pg. 1236 PAYMENT AUTHORIZATION FORM CHECK NO. CLAIM NO. E CHECK AMOUNT DATE OF ACCIDENT EMPLOYEE PAYEE o ADDRESS AUTHORIZATION/APPROVAL 0 DATE 0 U) [The rest of this page intentionally left blank.] 0 U) 0 c� 0 u cv 0 Page 21 of 21 Packet Pg. 1237 AC40� CERTIFICATE OF LIABILITY INSURANCE DATE(MMfDDNYYY) `.� 11/17/2016 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: N the certificate holder is an ADDITIONAL INSURED,the pollcy(les)must 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 CONTACT Geri Navarro NAME: AISI dba Pan American Insurance Agency, Inc. PHONE (925)407-0417 FAX A/C No:. CA License M OF89850 ADDRESS:gnavarro@ascensionins.com L � 1277 Treat Blvd., Suite 400 INSURER(S)AFFORDING COVERAGE NAICM Walnut Creek CA 94597 IN8URERA:TraVelers Prop. Cale. Co. of America 25674 INSURED INSURERB:Travelers Ind. Co. Of COnnecticrut 25682 Ascension Insurance Holdings, LLC INSURERC: Ascension Benefits 6 Insurance Solutions INSURERD: 700 SE Central Parkway IN8URERE: 91 9 Stuart FL 34994 0 INSURER F: (� COVERAGES CERTIFICATE NUMBER:CL166961192 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 r INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS E 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. I TTRR ADDLSUSR TYPE OF INSURANCE POLICY NUMBER popnnlyl POLICY EFF POLICY EXP LIMITS 0 A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE TO RE CLAIMS-MADE X❑OCCUR PREMISES Ea occurrence) $ 1,000,000 X 630OF426365TIL16 6/18/2016 6/18/2017 MEDEXP(Any one ) $ 5,000 0 PERSONAL&ADV INJURY $ 1,000,000 0 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000 ,000 1PRO POLICY JECT LOC PRODUCTS-COMPIOP AGG $ 2,000'000 OTHER: S NGLE LIMIT 0 B AUTOMOBILE LIABILITY Ea ecad enl 1 S 1,000,000 a0 ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED RAOF42609ATIL16 6/18/2016 6/18/2017 BODILY INJURY Per accident) $ 0 AUTOS AUTOS ( � X HIRED AUTOS X AUTOS EO PROPERTY accRideTMntOAMAGE $ 0. Non-owned S 0 UMBRELLA UAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION X PER OTH- 0 AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE EL EACH ACCIDENT $ 11000,000 `: OFFICERIMEMBER EXCLUDED? N I A . . (Mandatory In NH) YJUBOF401309TIL16 6/18/2016 6/18/2017 E.L DISEASE-EA EMPLOYEE S 1,000,000 H yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 0 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H mom space Is required) Monroe County BOCC is additional insured as required by contract. 4APPRD EMENT T-/A S CERTIFICATE HOLDER CANCELLATION ca to SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Monroe County BOCC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1100 Simonton Street ACCORDANCE WITH THE POLICY PROVISIONS. Suite 2-268 Key West, FL 33040 AUTHORIZED REPRESENTATIVE Steve Martin/GERI 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) Packet Pg. 1238 C.35.b ' ACCP CERTIFICATE OF LIABILITY INSURANCE 11/17/20F-DATE Y 6 �,/ 11/17/2016 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(les)must 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). CONT PRODUCER NAME:CT Geri Navarro AISI dba Pan American Insurance Agency, Inc. PHONE , (925)937-1483 4AX No: 1277 Treat Boulevard EL .gnavarro@ascensionins.com Suite 400 INSURE S AFFORDING COVERAGE NAICp Walnut Creek CA 94597 INSURERA:Great American E&S Insurance 0 INSURED INSURER B: Ascension Insurance Holdings, LLC INSURERC: Ascension Benefits 6 Insurance Solutions INSURERD. 700 BE Central Parkway INSURERE: 0 Stuart FL 34994 INSURER F: (� COVERAGES CERTIFICATE NUMBER:CL1612758012 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 r- 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 LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP LIMITS E COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO REWrE5_ CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any oneperson) $ PERSONAL&ADV INJURY $ 0 GEML AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ F1POLICY❑PECT RO a LOC PRODUCTS-COMP/OP AGG $ J OTHER: $ AUTOMOBILE LIABILITY COMBINED $ Ea accident _ ANY AUTO BODILY INJURY(Per person) $ M ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per exaietd S 0 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4 EXCESS LIAS CLAIMS�MADE AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION - 0 AND EMPLOYERS'LIABILITY STATUTE OR Y ANY PROPRIETORIPARTNERIEXECUT1VE ❑ N/A E.L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A ERRORS S cmissION$ TER3177425 1/31/2016 1/31/2017 Each Claim/Aggregate $15,000,00( CJ 0 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached N more space is required) DEDUCTIBLE: $50,000 each occurrence/$100,000 aggregate CID AP p IS A AGEMENT ed ed CD WAIVER N/A YES..-_ CERTIFICATE HOLDER CANCELLATION ca SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Monroe County BOCC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1100 Simonton Street ACCORDANCE WITH THE POLICY PROVISIONS. Suite 2-268 Key West, FL 33040 AUTHORIZED REPRESENTATIVE Steve Martin/DP �R C 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS026(201401) Packet Pg. 1239