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09/24/2019 to 09/26/2019 BOARD OF:COUNTY COMMISSIONERS County of Monroe ,07)m'cis !t. Mayor Sylvia J.Murphy,District 5 The Florida. Keys , Mayor Pro Tern Danny L. Kolhage,District 1 t Michelle Coldiron,District 2 Heather Carruthers,District 3 David Rice,District 4 Monroe County Board of County Commissioners . Office of the County Administrator The Historic Gato.Cigar Factory 1100 Simonton Street, Suite 205 Key West,FL 33040 (305) 292-4441 —Phone (305) 292-4544-Fax MEMORANDUM TO: Pam Hancock, Deputy ut Clerk FROM: Lindsey Ballard,Aide to County Administrator - . DATE: . September 4,2019 SUBJECT: Small Contracts Small contracts for your records only. Enclosures: Smarsh—:1 copy Health Designs, Inc— 1 copy Health Designs, Inc— 1:copy ATTACHMENT D.6 COUNTY ADMINISTRATOR CONTRACT SUMMARY FORM FOR CONTRACTS LESS THAN $50,000.00 Contract with: Health Designs,Inc. Contract# Effective Date: 09/24/2019 Expiration Date: 09/26/2019 Contract Purpose/Description: 2019 Employee Health and Wellness Fair biometric screening services; September 24,25 &26, 2019. BContract is Contract Am- s. u- . -n ion Renewal Contract Manager: Bryan Cook 4458 Employee Services/Stop#1 (Name) xt. (Department/Stop#) CONTRACT COSTS Total Dollar Value of Contract: $2,400.00 based on Current Year Portion: $ $2,400.00 based on (must be less than$50,000) estimated (If multiyear agreement then estimated participation. requires BOCC approval,unless the participation. total cumulative amount is less than $50,000.00). Budgeted? Yes[1 N1 Account Codes:502-08005-530490 Grant: $ - - - - County Match: $ - - - - ADDITIONAL COSTS Estimated Ongoing Costs: $ N/A /yr For: (Not included in dollar value above) (e.g. maintenance, utilities,janitorial,salaries,etc.) CONTRACT REVIEW Changes Date Out Date �n Needed Re e / Department Head '11L(' Yes❑ Np� ? IS Risk Management 5 c 3 1(( Yes❑ No172 11) d� -( O.M.B./Purchasing aMi(q Yes❑ NoR4 8/n/9 County Attorney e-a3--1 Yes❑ No • 5- -�f Comments: Page 70 of 73 Health Designs Healthier Employees.Healthier Results. Wellness Services & Fee Agreement— Monroe County BOCC 2019 This Wellness Services Amendment,dated as 2019, ("Agreement")is made between Health Designs, Inc.a Florida corporation, located at 35 Executive Way Suite 110, Ponte Vedra, FL 32082("Health Designs")and Monroe County BOCC("Client"). In consideration of the terms outlined below,the parties agree as follows: 1. Health Designs Services. Health Designs agrees to provide the following services("Services"): a. Onsite Health Screenings i. Full Lipid Panel—Included LDL and Triglycerides ii. Hemoglobin A1C—instant results through finger stick b. Schedule for the health screening events is: Sep 24,2019 9:OOam-3:00pm Sep 25,2019 9:OOam-3:O0pm Sep 26,2019 9:OOam-3:OOpm 2. Essential Planning Requirements. a. A minimum of 45 days'notice is required for Health Designs to attend an onsite event. This allows ideal timing for planning,marketing,and communications for shipping and supply needs to be met in timely manner. b. Client will provide accurate total population, in writing,to Health Designs no later than 30 calendar days prior to the event and Client will provide updated participation count no later than 10 business days prior to event ("Client's Estimate"). c. Health Designs standard screening times are between the hours of 7am and 5pm Monday through Friday; any times outside these times to be agreed upon with Client. d. If an event is cancelled by the Client within 10 business days of the event, Health Designs will be paid a 25% cancellation fee of the estimated total invoice.Any travel booked will be reimbursed in full. e. Changes to the times, reporting period,staffing or services,will be accommodated at the discretion of Health Designs and may result in an additional fee. 3. Client's Responsibilities. Client agrees to the following: a. Promote and communicate effectively to employees,details about the wellness program,the screening event and any incentives; 4. Fees,Payment Schedule and Insurance. a. Fees: 1. Full Lipid Panel-$5 per participant. a. Please note this is not optional per participant. Each person that attends will receive this service 2. Hemoglobin Al C-$19.95 per test b. Payment Schedule, Invoices will be sent upon completion of services and Client shall pay invoices within 30 days. Payments not made within 30 days shall accrue interest at the lesser of the maximum rate allowed by law or 1%per month;Client shall be responsible for all costs of collection including legal fees and costs. c. Dispute Resolution. This Agreement shall be governed by the laws of the state of Florida, conflict of laws notwithstanding. Any disputes shall be resolved in a court of competent jurisdiction located in Monroe County, Florida. The parties waive any right to a jury trial. d. Insurance: Health Designs shall maintain during the terms of this Agreement professional liability insurance in a minimum amount of$500,000;general liability insurance in a minimum amount of$300,000; and vehicle liability in a minimum amount of$100,000 covering all liability arising out of the terms of this Agreement. Health Designs shall provide original insurance certificates listing the Monroe County Board of County Commissioners as certificate holder and additional insured within ten(10)days following approval of this agreement by the Monroe County Board of County Commissioners. In addition, Health Designs shall provide a certificate showing evidence of worker's compensation coverage in statutory amounts, and Employer's Liability insurance in the minimum amount of$500,000. e. Public Records and Audits. 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: 1) a. Keep and maintain public records required by Monroe County in order to perform the service. 1 2) 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. 3) 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. 4) 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 Monroe County. IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES,TO THE 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@monroecounty-fl.gov, c/o Monroe County Attorney's Office, 1111 12th St., Suite 408, Key West FL 33040. Agreed to by: Monroe County BOCC , Signature: `� i /� ate: 08'30.19 Name and Title: 120MRl't G-tuJ¢r CO nli'l!✓'•1f'R raharn fluing oun Administrator Health Designs 12j Signature: "�'f' '� ya'k' Date: 08/21/19 Name and Title:Britney Hollyoak, Lead Project Manager 35 Executive Way,Suite 110•Ponte Vedra Beach,Fl 32082•904.285.2019 •www.healthdesigns.net OMROE COUNTY ATTORNEY APP VEO..OS TprF is 0.Q... n "!' Data: —a — o 2 A►R D® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 8/26/2019 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 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). CACT PRODUCER NAME: Laura Holzhauser Harden PHONE FAX 501 Riverside Avenue, Suite 1000 (A/C.No,Ext):904-354-3785 (alc.No):904-634-1302 Jacksonville, FL 32202 ADDRESS: LHolzhauser@hardeninsight.com INSURER(S)AFFORDING COVERAGE NAIC M INSURER A:Old Dominion Insurance Co 40231 INSURED INSURER B: Health Designs, Inc. INSURERC: 35 EXECUTIVE WAY SUITE 110 Ponte Vedra Beach FL 32082 INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:490791012 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 EFF POLICY EXP/Y LIMITS LTR INS) WVD POLICY NUMBER (MMIDDYYY) (MMIDD/YYYY) A X COMMERCIAL GENERAL LIABILITY BPP0173N 4/12/2019 4/12/2020 EACH OCCURRENCE $1,000,000 DAMAGE TO CLAIMS-MADE X OCCUR PREMISES(EaENTED occurrence) $500,000 MED EXP(Any one person) $10,000 PERSONAL 8 ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY PRO LOC PRODUCTS-COMP/OPAGG $2,000,000 X PRO- OTHER: $ A AUTOMOBILE LIABILITY BPP0173N 4/12/2019 4/12/2020 (Ea COMBaccident)INED SINGLE LIMIT $Included ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY _(Per accident) $ UMBRELLA LIAB OCCUR APP ''o BY MA IEIT EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE �Y I '� AGGREGATE• $ DED RETENTION$ WORKERS COMPENSATION DATE ' )• .� % STATUTE OTH - ER AND EMPLOYERS'LIABILITY Y/N J _ ANYPROPRIETOR/PARTNER/EXECUTIVE l E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? N/A WAIVER N/A� YES__ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Monroe County Board of County Commissioners and additional insured are Additional Insured under this policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Monroe County Board of County Commissioners and ACCORDANCE WITH THE POLICY PROVISIONS. additional insured Attn: Natalie Maddox 1100 Simonton Street 2-268 AUTHORIZED REPRESENTATIVE Key West FL 33040 draw 2/1 4654(11A- ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Act CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 441......-----' 08/27/2019 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 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). PRODUCER CONTACT NAME: Pinkham Agency Inc PHO No.Ext): (516)931-1414 FAX No): (516)827-4280 40 COMMERCE PLACE E-MAIL ADDRESS: STE.100 INSURER(S)AFFORDING COVERAGE NAIC Y HICKSVILLE NY 11801 INSURER A, Continental Casualty Company INSURED INSURER B: Health Designs Inc. INSURER C: 35 Executive Way Suite 110 INSURER D: INSURER E: Ponte Vedra Beach FL 32082 INSURER F: COVERAGES CERTIFICATE NUMBER: CL197900474 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.LIM,ITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL POLICY EFF POLICY EXP LIMITS TR TYPE OF INSURANCE INSQ WVP POUCY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE S DAMAGE TO RENTED ICLAIMS-MADE Ell OCCUR PREMISES(Ea occurrence) $ ,q¢•vr� �IS)C NI^: � T MED EXP(Any one person) $ PERSONAL BADV INJURY 5 BY GEN-'LAGGREGATEUMITAPPLIESPER: : .� /� / GENERAL AGGREGATE $ POLICY 0 JEC 0LOC 5 OTHER: DA WAIVER /ASr- PRODUCTS-COMP/OP AGG $ COMBINED SINGLE LIMIT $ AUTOMOBILE UABILITY (Ea accident) BODILY INJURY(Per person) S ANY AUTO .— OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS PROPERTY DAMAGE 5 HIRED NON-OWNED • (Per accident) AUTOS ONLY _ AUTOS ONLY 5 X UMBRELLAUAB OCCUR EACH OCCURRENCE $ 2,000,000 A - EXCESS LIAB HMC4032331610-0 10/30/2018 10/30/2019 AGGREGATE 5 2,000,000 CLAIMS•MADE S DED I I RETENTION 5 WORKERS COMPENSATION ST STATUTE _ ERH AND EMPLOYERS'LIABIUTY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE n N IA E.L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L DISEASE-EA EMPLOYEE $ If yes,describe under E.L.DISEASE-POLICY LIMIT 5 DESCRIPTION OF OPERATIONS below _ Incident 1,000,000 Professional Liability Y HMA4032331607-0 10/30/2018 10/30/2019 Aggregate 3,000,000 A Claims Made Retro Date 8/14/2004 DESCRIPTION OF OPERATORS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Certificate holder is included as additional insured if required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF T ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION D• E THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WIT THE POLICY PROVISIONS. Monroe County Board of County Commissioners ; I 1100 Simonton Street 2-268 AUTHORIZED REPRESEN1•T Key west FL 33040 I 198:- 115 •CORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks f ACORD ACORD' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/17/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION 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 NAME: Vicky Zelen Zelen Risk Solutions,Inc. (A PHONE F1d).904-262-8080 FAX NoI:904-262-1444 7964 Devoe Street E-MAIL vicky@zelenrisk.com INSURER(S)AFFORDING COVERAGE NAIC# Jacksonville FL 32220 INSURERA: The Hartford Casualty Insurance Company INSURED INSURER B Health Designs,Inc. INSURER C 35 Executive Way,Suite 110 INSURER D: INSURER E: Ponte Vedra Beach FL 32082 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 EFF POLICY EXP LIMITS LTR JNSR wvn POLICY NUMBER IMMIDD/YYYYI /MMIDD/YYYYI GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PRFMISFS(Fa nnnurrenna) $ • CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ _ MA T GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: A -M PRODUCTS-COMP/OP AGG $ _ nPRO- n LOC !tY TE2I -.-�.�—POLICY I TY COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY CO(Fa BIKED ANY AUTO �A BODILY INJURY(Per person) $ ALL OWNED SCHEDULED WAIVER WA--YES BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS _ AUTOS (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTION$ S WORKERS COMPENSATION X TWCYM -S OR- AND EMPLOYERS'LIABILITY ANY A OFFICER/MEMBER/EXCLUDED?ECUTIVE N I A 21 WECADI HBU 05/05/2019 05/05/2020 E.L.EACH ACCIDENT $1,000,000 (Mandatory In NH) I I E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION Monroe County Board of County Commissioners SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATTN: Natalie Maddox ACCORDANCE WITH THE POLICY PROVISIONS. 1100 Simonton Street,Suite 2-268 Key West,FL 3304 AUTHORIZED REPRESENTATIVE , /� II- ryy) zgeh<VM , Z> V ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Client#: 2145969 • 04CLEARTRAI YYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(M8/30/MIDDIWDD/ 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 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: McGriff Insurance Services PHONE(A/C,No,Ext):888 743-2217 FAX (A/C,No): 8888279861 414 Gallimore Dairy Road E-MAIL ADDRESS: Suite F INSURER(S)AFFORDING COVERAGE NAIC# Greensboro, NC 27409 INSURER A:Landmark American Insurance Co 33138 INSURED INSURER B: ClearTrack HR, LLC INSURER C: 305A Quality Circle INSURER D: Huntsville,AL 35806 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 INSR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MMIDDIYYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS-MADE OCCUR PREMISESCO{Ea occu ante) S MED EXP(Any one person) $ PERSONAL 8 ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S PRO- POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) S _ OWNED SCHEDULED BY 16K MA T AUTOS ONLY AUTOS ����{{�,, BODILY INJURY(Per accident) $ HIRED NON-OWNED ( ',Y/u 2 PROPERTY DAMAGE S AUTOS ONLY _ AUTOS ONLY SY (Per accident) 9 UMBRELLA LIAB _ OCCUR DAT / �� -`s` EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE WAIVERA� AGGREGATE S DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N _—STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A --—— (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S A Professional LCY774239 01/31/2019 01/31/2020 1,000,000/3,000,000 Liability DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Policy Number: LCY774239 Professional Services Error:Aggregate$1,000,000 Each Claim 1,000,000 Ded:$5,000 Retro Date 01/31/18 Technology Services Error:Aggregate$1,000,000 Each Claim 1,000,000 Ded:$5,000 Retro Date 01/31/18 Media Activities Error:Aggregate$1,000,000 Each Claim 1,000,000 Ded:$5,000 Retro Date 01/31/18 Network Security Error:Aggregate$1,000,000 Each Claim 1,000,000 Ded:$5,000 Retro Date 01/31/18 (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION Monroe CountyBoard of CountySHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Commissioners • ACCORDANCE WITH THE POLICY PROVISIONS. • 1100 Simonton Street Suite 2-268 Key West, FL 33040 AUTHORIZED REPRESENTATIVE kW ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S24261569/M23896417 LRN DESCRIPTIONS (Continued from Page 1) Regulatory Matter:Aggregate$1,000,000 Each Claim 1,000,000 Ded:$5,000 Retro Date 01/31/18 Privacy Breach:Aggregate$1,000,000 Each Claim 1,000,000 Ded:$5,000 Data Assets Corruption:Aggregate$1,000,000 Each Claim 1,000,000 Ded:$5,000 Cyber Extortion Threat:Aggregate$1,000,000 Each Claim 1,000,000 Ded:$5,000 Electronic Business Interruption:Aggregate$1,000,000 Each Claim 1,000,000 Cyber Crime:Aggregate$100,000 Each Claim$100,000 Ded:$5,000 SAGITTA 25.3(2016/03) 2 of 2 #524261569/M23896417 cc-s %Ai THE HARTFORD colt BUSINESS SERVICE CENTER THE `'' '° 3600 WISEMAN BLVD HARTFORD SAN ANTONIO TX 78251 August 30, 2019 Monroe County Board of County Commissioners 1100 SIMONTON ST STE 2-268 KEY WEST FL 33040-3110 Account Information: Contact Us Policy Holder Details : CLEARTRACK HR, LLC Business Service Center Business Hours: Monday- Friday (7AM -7PM Central Standard Time) Phone: (866)467-8730 Fax: (888)443-6112 Email: agency.services a(�thehartford.com Website: https://business.thehartford.com 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 WLTR005 A ��' DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 08/30/2019 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 NAME: MCGRIFF SEIBELS&WILLIAMS INC 21250036 PHONE (866)467-8730 FAX (888)443-6112 (A/C,No,Ext): (A/C,No): PO BOX 10265 BIRMINGHAM AL 35202 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Twin City Fire Insurance Company 29459 INSURED INSURER B: CLEARTRACK HR,LLC INSURER C: 305 QUALITY CIR NW#A HUNTSVILLE AL 35806-4542 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 SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MMIDD/YYYY) (MM/DD/Y YYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $2,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED $1,000,000 PREMISES(Ea occurrence) x General Liability MED EXP(Any one person) $10,000 A X 21 SBA RS9035 01/12/2019 01/12/2020 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY PRO- X LOC PRODUCTS-COMP/OP AGG $4,000,000 JECT OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $2,000,000 (Ea accident) _ ANY AUTO BODILY INJURY(Per person) —ALL OWNED SCHEDULED A X 21 SBA RS9035 01/12/2019 01/12/2020 BODILY INJURY(Per accident) _AUTOS AUTOS HIRED NON-OWNED PROPERTY DAMAGE X AUTOS X AUTOS (Per accident) _ UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- pp MADE Apfrbi S {y �l*1I6 AGEMENT AGGREGATE DED RETENTION$ • WORKERS COMPENSATION SY _ PER OTH- AND EMPLOYERS'LIABILITY DATE / STATUTE ER ANY Y/N E.L.EACH ACCIDENT PROPRIETOR/PARTNER/EXECUTIVE — N/A WAIVER W/tk _ YES.-- -- - OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT • DESCRIPTION OF OPERATIONS below A EMPLOYMENT PRACTICES 21 SBA RS9035 01/12/2019 01/12/2020 Each Claim Limit $10,000 LIABILITY Aggregate Limit $10,000 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 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Board of County Commissioners BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED 1100 SIMONTON ST STE 2-268 IN ACCORDANCE WITH THE POLICY PROVISIONS. KEY WEST FL 33040-3110 AUTHORIZED REPRESENTATIVE LJ G�6`Gt/7 !aQ&„,„v2> ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD