Loading...
1st Extension 09/24/2019 o BOARD OF COUNTY COMMISSIONERS County ®f Monroe Mayor Sylvia J. Murphy,District 5- The Florida Keys z a Mayor Pro Ten Danny L. Kolhage,District 1 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 0 1 8 2019 Key West, FL 33040 By; (305) 292-4441 —Phone (305) 292-4544-Fax MEMORANDUM TO: Pam Hancock; Deputy Clerk FROM: Lindsey Ballard, Aide to County Administrator DATE: October 17, 2019 SUBJECT: Small Contracts Small contract for your records only. Enclosures: A-1 Property Services— 1 copy enclosed Falck Southeast H Corps— 1 copy enclosed . Monroe County Purchasing Policy and Procedures ATTACHMENT D.6 COUNTY ADMINISTRATOR CONTRACT SUMMARY FORM FOR CONTRACTS LESS THAN$50,000.00 Contract with: aick„Southeaat it Corpo:. Contract# d/b/a American Ambulance Effective Date: fir?"- Service ,:-_,I I Expiration Date: Afxil 30,2020 Contract Purpose/Description: T s.agniagoem pso,sFbfi 6ertt}xxtaY«r?kx Alletirasiy,Mena4ed Spr.Jal Nem%Rogatry z40,-f a to t%rocii g.kxne or A-fated t h fly Fat••i,on kip r pnniand in die event of art evacuation ofifiloproe County rnsoiapts.This O'ndrrten!stvtal ektaixi that agreement by seven(7)'I .4:t % Contract is Original Agreement Contract Amendinen Extension enewal Contract Manager: .I.M.Massoud 288-6043 erge.• Management/ Stop 14 (Name) (Ext.) (Department/Stop #) CONTRACT COSTS Total Dollar Value of Contract: $ Tgo Current Year Portion: $ (must be less than S50,000) 1rTE (If multiyear agreement then requires BOCC approval,unless the , $49,c'"s9.`a'Ix total cumulati'e amount is less than 5 50,000.00) Budgeted?Yes❑ No 0 Account Codes: - - - - Grant: $ N/A - - - County Match: $ NIA — — — — ADDITIONAL COSTS Estimated Ongoing Costs: $0.00 /yr For: (Not included in dollar value above) (e.g.maintenance,utilities,janitorial,salaries,etc.) CONTRACT REVIEW Changes Date ut to Needed �'e -wee y Department Head t ci YesO No[1] .i�L J& .' L.s.A.. !b 1 n t rrG . I Risk Management 1j k 1 Yes❑No1.4 k _ 1 Itre c O.M.B./Purchasing 10I(°IIq YesO No ![/ (714. 19)10 CIac1 County Attorney )4 e't/IC\ Yes❑NoN tit i (' S Comments: Page 80 of 91 Monroe County Purchasing Policy and Procedures ATTACHMENT D.6 COUNTY ADMINISTRATOR CONTRACT RENEWAL FORM FOR CONTRACTS LESS THAN $50,000.00 Contract with: Feick Southeast II Corps Contract# Renewal Date: September 24,2019 Expiration Date: April 30,2020 Contract Renewal Notes: This agreement provides transportation for Medically Managed Special Needs Register dients to nursing homes or assisted living facilities on the mainland in the event of an evacuation of Monroe County residents. This amendment will extend that agreement by seven(7)months. FAILURE TO MEET ONE OR MORE OF THE CONDITIONS SET FORTH BELOW WILL REQUIRE APPROVAL BY THE BOCC ❑The BOCC approved agreement provided for a renewal subject to the terms and conditions set forth in in the initial contract. ❑The Contractor has performed in a satisfactory manner and the contract manager has verified satisfactory performance 0 The Contractor has requested and agrees to renewal (renewal agreement should first be signed by Contractor) ❑ The renewal period is set forth in the BOCC approved agreement B The total cumulative value, including any Consumer Price Index(CPI) increase, of the renewal is less than$50,000.00 The following ContIii/ nager has verified that the above conditions have been met. Contract Manager: Z_ ._ - (,-c f.5 i'f-r y� / (Name) (Ext.) (Department/S top #) Revised BOCC 7/17/19 Page 74 of 86. COUNTY OF MONROE AGREEMENT BETWEEN FALCK SOUTHEAST If CORP. D/B/A AMERICAN AMBULANCE SERVICE AND MONROE COUNTY, FLORIDA FOR THE TRANSPORTATION OF MEDICALLY MANAGED SPECIAL NEEDS PATIENTS DURING AN EMERGENCY FIRST AMENDMENT (EXERCISING OPTION TO EXTEND FOR SEVEN ADDITIONAL MONTHS) This is an amendment(First Amendment) to the contract dated September 24,2018, ("Ambulance Contract") by and between the Board of County Commissioners of Monroe County, Florida (hereinafter"County") and Falk Southeast II Corp. d/b/a American Ambulance Service(American Ambulance), a foreign for-profit licensed to do business in the State of Florida (collectively, the "Parties"). WHEREAS, on September 24,2018, the parties entered into the Ambulance Contract covering the transportation of the County's medically managed special needs for a term of one(1) year; and WHEREAS, the County wishes to exercise the option to extend the Audit Contract for seven (7) additional months; and WHEREAS, the base fee in the Ambulance Contract as originally stated (Attachment A) has not increased since inception of the Ambulance Contract not to exceed $49,999.99 per event; and WHEREAS, Charlie Maymon has retired from Falck Southeast II Corp. and has been replaced by Michael Arguelles as the Point of Contact for American Ambulance. NOW, THEREFORE, in consideration of the mutual promises, benefits and covenants set forth herein, the Parties agree as follows: 1. Under Section 4, TERM, a new paragraph 3.2 is added, to read as follows: 3.2 This Agreement is hereby extended for Seven (7) additional months, until April 30,2020. 2. Under Section 7,NOTICES, the Point of Contact for American Ambulance will be changed to: Michael Arguelles, Regional COO, Falck Easter Seaboard, 7260 NW 6811' Street, Miami, FL, 33066 3. In all other respects, the terms and conditions of the Ambulance Contract dated September 24,2018, remain in full force and effect. S IN WITNESS WHEREOF, the Parties hereto have caused this agreement to be executed on the day and year first above written. 1�t Amendment American Ambulance MEAL) MU=KEVIN MADOK,CLERK BOARD OF CUMIN COMMISSIONERS OFr,iOIl ® JtI FLORIDA ' ) 40I /0li2d/9 �� rater - Depaity Clark •�;:-i t•?:air �� (�K�rau:�. Ma B coo pnikted Name: Jorge Lopez Mated N EY EO PEDP10 MERCADO ASSISTANT NN A 1st Amendment American Ambulance 2 �„ BOARD OF COUNTY COMMISSIONERS y� County of Monroe ` 't. Mayor David Rice,District •The Florida Keys 4 A�t.1 Mayor Pro Tern Sylvia J.Murphy,District 5 Danny L.Kolhage,District 1 George Neugent,District 2 ,. / Heather Carruthers,District 3 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 Clerk FROM: Lindsey Ballard,Aide to County Administrator' DATE: September 25, 2018 SUBJECT: Small Contracts • These small contract is for your records only. Enclosures: Falck Southeast II Corp.d/b/a American Ambulance Services—1 Copy enclosed — Progent Group—1 Copy enclosed A Monroe County Purchasing Policy and Procedures ATTACHMENT D.6 COUNTY ADMINISTRATOR CONTRACT SUMMARY FORM FOR CONTRACTS LESS THAN$50,000.00 Contract with• Falk:�SLilliea�t"'I`I , Contract# orp. American Effective Date: ' Ambulance Services Expiration Date: Contract Purpose/Description: This agreement provides transportation for Medically Managed Special.Needs Registry clients-toa Nursing Home or Assisted Living Facility on the;tnainland in the:event of an:evacuation of .,,Monroe'County residents. :: Contract is Original Agreement Contract Renewal • Contract Manager: • er: _.._.,. �. .�� , -•-_. ...:_..;.:.;.; ...�,. g 1:M:Massoud - 1289-6043 Emergency•Management/.Stop-14 (Name): : (Ext.) " (Department/Stop#) : • •CONTRACT COSTS • Total Dollar:Value of Contract: $ Current Year Portion: $ -` y7, .I (must be less than$50,000) ` (If multiyear agreement then t NTE " requires BOCC approval,unless the l total cumulative amount is less than t$49;999.99: .. $50,000.00). :? . .Budgeted? YesD No�x Account Codes: - - - - Grant: $ N/A - • County Match:$ N/A . . - . - - - • ADDITIONAL COSTS Estimated Ongoing Costs:$0.00 /yr For: (Not included in dollar value above) .. . (e.g.maintenance,utilities,janitorial,salaries,etc.) CONTRACT REVIEW Changes Date Out • Date'In Needed ,ever •. - Department Head 9-/2-/YYes❑No1611 ��; ,�---- y^/,7 -/'< Risk Management f'1q YesD Noce?: - -16/ O:14.B./Purchasing�.IID:I YesL Nod qh'f jq: ... ::. . . County Attorney 1-14-atilt Yes❑Not' 9-17-:a0e Comments: Page 67 of 70 Agreement between Falck Southeast II Corp. d/b/a American Ambulance Service and Monroe County, Florida for the Transport of Medically Managed Special Needs Patients During An Emergency. • THIS AGREEMENT is made and entered into this d 4 day of Pere?' n i'('` , 2018 by and between MONROE COUNTY, a political subdivision of the State of Florida, with principal offices FALCK SOUTHEAST II CORP. dba AMERICAN AMBULANCE SERVICE ("American Ambulance"), a foreign for-profit business located at 6605 NW 74th Ave.,Miami, FL 33166. WITNESSETH: WHEREAS, the County currently has approximately numerous persons currently enrolled on the County's Special Needs Registry, who will need assistance with transport in event of an evacuation during an emergency; and WHEREAS, some portion of those individual will constitute persons who, in the opinion of the local Department of Health, will have medical needs that cannot be met at a special needs shelter because they are disabled, medically dependent oh electricity, require a nurse's care;or must be in a hospital setting for 24-hour care, and who therefore must be transported to a nursing home, skilled nursing facility or other facility outside the area of the event ("Medically Managed Special Needs Patients"); and WHEREAS, tlie County's Comprehensive Emergency Management Plan (CEMP), which has been approved both by the Board of County Commissioners and the State of Florida Division of Emergency Management, provides that special needs clients may be sheltered in a designated in-county location in the event of a Tropical Storm or low Category 1 storm, but will generally otherwise be evacuated to an out-of- county location, and that Medically Managed Special Needs Patients will be advised of their need to evacuate in the event of an out-of-county evacuation order; and WHEREAS, the CEMP provides that it is the intention of the County, to the best of its ability, to provide for the safety of the elderly and handicapped special needs population whose safety is not provided for through affiliation with another organization, and that transport for the evacuation of the special needs population is the responsibility of Monroe County Social Services and care of the clients is the responsibility of the Monroe County Department of Health; and WHEREAS, in April 2018, the responsibility for maintaining a Special Needs registry and supervision of transport of Medically Managed Special Needs patients was transferred from the Social Services Department to the Emergency Management Department; and WHEREAS, the County wishes to prepare for the evacuation and transport of medically managed special needs persons from various locations within Monroe County; Florida, to nursing homes, skilled nursing facilities and hospitals located inside or outside the County, in the event of an emergency; and WHEREAS, American Ambulance desires to offer transportation services for medically managed special needs patients, up to one (1) caretaker per patient, and the patient's caged or crated service animals during the evacuation and re-entry phases of an emergency as determined by Monroe County Emergency Management. NOW THEREFORE, COUNTY and American Ambulance, through their respective governing Page 1 of 13 • bodies, and in consideration of the mutual promises and covenants herein contained, hereby agree as follows: Section 1. Definitions 1.1 "Advanced Life Support" or"ALS" shall mean advanced life support, as that term is defined by in Chapter 401,Florida Statutes. 1.2 "Basic Life Support" or "BLS" shall mean basic life support, as that term is defined in Chapter 401,Florida Statutes. 1.3 "Ambulance" shall mean an emergency medical services vehicle used in the transport of patients, as defined in Section 401.23,Florida Statutes. 1.4 Other capitalized terms in this Agreement shall have the meanings set forth in Section 401.23, Florida Statutes. Section 2. Services. 2.1 In the event of a local declaration of emergency and notification by the County that the services under this Agreement are required, American Ambulance shall provide transportation for designated medically managed special needs patients, up to one (1) caretaker per patient, and up to one (1) properly caged or crated service animal belonging to the patient, in accordance with the attached Scope of Services rate sheet (Attachment A). The point of origin for the trip shall be the residence of the patient. The patient will be transported to a nursing home, skilled nursing facility, or other similar location designated by the County. The return trip shall be from the nursing home, skilled nursing facility or other similar location to point of origin. 2.2 The services will commence when a local state of emergency is declared by Monroe County Emergency Management and American Ambulance is contacted by County to begin the service. 2.3 American Ambulance has, and shall maintain throughout the term of this Agreement, appropriate licenses to perform the services under this Agreement; proof of such licenses shall be submitted to the County upon request. Section 3 Payment and Spending Cap. • 3.1 Subject to the language in Section 2.2, the County shall be responsible for payment of invoices following presentation of a proper invoice for services in accordance with the Florida Local Government Prompt Payment Act. 3.2 Monroe County's performance and obligation to pay under this contract is contingent upon an annual appropriation by the Board of County Commissioners. 3.3 The maximum amount that may be incurred or paid under this Agreement is forty-nine thousand nine hundred ninety-nine dollars and ninety-nine cents ($49,999.99). Section 4 Term This Agreement shall commence on upon the date -of execution by the last signatory to the Agreement ("Effective Date") and shall run for one (1) year from the Effective Date, unless terminated Page 2 of 13 earlier under paragraph 4 of this Agreement. Section 5. Termination This Agreement may be terminated at the discretion of either party upon not less than sixty (60) days' written notice to the other party; however, this Agreement may not be terminated by American Ambulance during hurricane season (June 1 — November 1), unless by prior written mutual agreement of the parties. Section 6. Requirements for Evacuation and Transportation of Service Animals Service animals to be transported must be properly caged or crated, must have pre-registered, and must have the appropriate documentation and current vaccinations as set forth in the Monroe County Pet Friendly Hurricane Evacuation Center Registration Guidelines. Section 7. Notices. All notices and other communications required under this Agreement must be in writing and addressed as follows: FOR COUNTY: Marty Senterfitt,Director Emergency Management 490 63`d Street, Suite 150 Marathon,Florida 33050 Matthew Massoud, Sr. Planner/Special Needs Emergency Management 490 63`d Street, Suite 150 Marathon, Florida 33050 FOR AMERICAN AMBULANCE: Charlie Maymon President, Falck Southeast II Corp. 6605 NW 74th Ave., Miami,FL 33166 Any Notice required by this Agreement shall be deemed to have been duly given if sent by certified mail, return receipt requested, postage and fees prepaid; hand delivered; facsimile; or by'overnight delivery service with proof of delivery. Section 8. Governing Law,Venue,Interpretation. This Agreement shall be governed by and construed in accordance with the laws of the State of Florida applicable to agreements made and to be performed entirely in the State. In the event that any cause of action or administrative proceeding is instituted for the enforcement or interpretation of this Agreement,the County and American Ambulance agree that venue will lie in the appropriate court or before the appropriate administrative body in Monroe County, Florida. Mediation conducted regarding this Agreement shall be performed according to the rules of the 16th Judicial Circuit for Monroe County, Florida. This Agreement is not subject to arbitration. Page 3 of 13 Section 9. Entire Agreement/Modification/Amendment. This writing sets forth the entire agreement of the parties with respect to the subject matter of this Agreement. No representations were made or relied upon by either party, other than those expressly set forth herein. No agent, employee, or other representative of either party is empowered to modify or amend the terms of this Agreement, unless in writing signed by both parties. Section 10. Access to Records and Audits. American Ambulance 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 regular business hours during the term of the Agreement and for four years following the termination of this Agreement. If an auditor employed by the County or Clerk determines that monies paid to American Ambulance pursuant to this Agreement were spent for purposes not authorized by this Agreement, American Ambulance shall repay the monies together with interest calculated pursuant to Sec. 55.03, FS, running from the date the monies were paid to American Ambulance. Section 11. Non-Reliance By Non-Parties. 11.1 No person or entity shall be entitled to rely upon the terms of this Agreement in order to enforce or attempt to enforce any third-party claim or entitlement to or benefit from any service or program contemplated hereunder, and County and American Ambulance agree that neither party, nor 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. 11.2 Both parties understand that the employees provided by American Ambulance-for the purpose of this Agreement remain the employees of American Ambulance. Execution of this Agreement does not create any employment relationship, contractual or implied, between said employees and the County. Section 12. Taxes. • The County is exempt from,payment of Florida State Sales and Use taxes. American Ambulance shall be responsible for any and all taxes, or payments of withholding, related to services. rendered under this Agreement. Section 13. Insurance. Prior to or at the time of execution of this agreement, American Ambulance shall furnish the County Certificates of Insurance indicating current coverages in at least the minimum amounts shown in Attachment C. The County shall be named as an additional insured on all general liability and vehicle liability policies. Each policy certificate shall be endorsed with a provision that not less than thirty (30) calendar days' written notice shall be provided to the County before any policy or coverage is canceled or restricted. The underwriter of such insurance shall be qualified to do business in the State of Florida. American Ambulance will update the County and provide the County with updated proof of Page 4 of 13 insurance and/or certificates of insurance as the term of insurance expires and coverage for a new term is bound. Section 14. Severability. If any term or provision of this Agreement shall to any extent be held invalid or unenforceable, the remainder of this Agreement shall not be affected thereby, and each remaining term and provision shall be valid and enforceable to the fullest extent permitted by law. Section 15. Waiver. The failure of either party to this Agreement to object to or take affirmative action with respect to any conduct of the other in violation of any term or condition of this Agreement shall not be construed as a waiver of the violation or breach,or a waiver of any future violation,breach,or wrongful conduct, Section 16. Counterparts. This Agreement may be executed in'several counterparts, each of which shall be deemed an original and such counterparts shall constitute one and the same instrument. Section 17. Authority. : • Each party to this Agreement represents and warrants to. the other that the execution;.delivery and. performance of this Agreement have been duly authorized by all necessary County, corporate or individual action,as required by law. . Section 18. Covenant of No Interest. The parties covenant that they do not presently have any interest, and shall not. acquire any interest,. which would conflict in,any manner or degree with performance under this.Agreement, and that the only interest of each is to perform and receive.benefits as recited in this Agreement. . • Section 19. Code of Ethics. The County and-.American.Ambulance agree that officers and employees of the County are required to comply with the standards of conduct for public officers and employees as delineated in Section 112.313, Florida Statutes, and the County's policies,regarding,but not limited to, solicitation or acceptance of gifts; doing business with one's agency; unauthorized compensation; misuse of public position, conflicting employment or contractual relationship;and.disclosure or use of certain information. . Section 20. No Solicitation/Payment: . . Each party warrants that,with respect to itself,it has neither employed nor retained any company person, other than a bona fide employee working solely for it,to solicitor secure this Agreement and that ithas 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 American Ambulance 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, • commission,percentage,gift,or consideration. Section 21. Non-Waiver of Immunity. Notwithstanding the provisions of Sec.. 768.28,Florida • Statues, the participation of COUNTY 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 contract entered into by the COUNTY be required to contain any provision for waiver. 0 • • Page 5of13 ' - • • • • • Section 22. Cessation of Services. American Ambulance reserves the right to suspend services under this Agreement, if, in American Ambulance's sole judgment, services under this Agreement cannot be operated safely or without unacceptable risk to person or property. Section 23. Federal and State Required Contract Clauses. The clauses included in Attachment.B are required by federal or state statute and are incorporated in this Agreement by reference. • ' Section 24. CompIiance with Federal,State and Local Laws. • • Both parties agree to comply with all federal,state and local laws in performance of this Agreement. Section 25. Hold Harmless and Indemnification. To the extent allowed by Florida law,American Ambulance agrees to defend and indemnify the County and its elected and appointed officials and employees from any and all claims and suits brought by a third party, arising out of American Ambulance's performance of services under this Agreement. IN WITNESS WHEREOF, the parties hereto have entered into this Agreement the day and year executed by both parties. • FALCK SOUTHEAST II CORP. MONROE COUNTY BOARD OF COUNTY DOING BUSINESS AS AMERICAN AMBULANCE • COMMISSIONERS SERVICE B B Y• • • • y Charles aymon,Pre ent Roman Gastesi, County Administrator • Date signed: ck- 1 Z - Z©1 • Date signed: �t1M ber l cf • IVIONROECEEO�� JUNTTYATTORNEY PRG ,� -A 0. FOR : CYNTHIA L. HALL ASSISTANT COUNTY A ORNEY Date R't ' Page 6 of 13 Attachment A SCOPE OF SERVICES AND RATES Basic cost per Basic Life Support(BLS) Transport (each way) $264.21 Cost per BLS mile (loaded) $7.45 Basic cost of Advanced Life Support(ALS) Transport(each way) $298.21 Cost per ALS mile(loaded) $7.45 Cost for caretaker and special needs animals $0 (no cost) Cost for second patient transported in same vehicle 20% discount on total of(basic cost+ cost per mile) 1. American Ambulance will transport a maximum of two (2)patients per ambulance. 2. The County will use its best efforts to provide 24 hours' prior notice of need to the company. 3. At the time of notification, the County shall provide a list of patients for transport and information regarding the destination. Each patient is responsible for providing all necessary medical records to the company. In the event of an emergency, American Ambulance will provide sufficient ALS and BLS assets, and personnel, within a maximum of 24 hours from moment of notification, to transport all of the County's medically managed special needs patients to places where the patients will be housed during the'emergency. The destinations may be within or outside Monroe County, depending on the location of the emergency. 4. Each Ambulance will be staffed with a minimum of one driver and one EMT (for BLS vehicles) or one driver plus one paramedic (for ALS vehicles). 5. At the time of notification from the County that the services under this Agreement are required, the County and American Ambulance shall each designate the primary point of contact and a backup person for purpose of the services and shall provide all necessary contact information for each of those people. Those individuals shall have all authority to make necessary decisions on behalf of their respective entities. 6. American Ambulance's BLS Ambulances shall be equipped and staffed to provide medical treatments, procedures, and techniques administered or performed by an Emergency Medical Technician (EMT), as that term is defined in Chapter 401, Florida Statutes. 7. American Ambulance's ALS Ambulances shall be equipped and staffed to provide medical treatments, procedures, and techniques administered or performed by an Emergency Medical Technician (EMT), as that term is defined in Chapter 401, Florida Statutes. 8. All Ambulances shall be equipped, maintained and operated in accordance with the laws of the State of Florida. American Ambulance shall provide appropriate disposable and durable medical supplies on each dedicated Ambulance. • Page 7 of 13 ATTACHMENT B FEDERAL AND STATE CONTRACT CLAUSES Provisions Required by 2 CFR part 200. 1.1 Termination: Either party may terminate this Agreement without cause upon ninety (90) days' notice of • intention to do so to the other party; however, this provision may not be exercised during hurricane season (June 1 to November 30) unless both parties mutually agree to terminate. In the event of termination, the County shall owe for all goods and services delivered prior to the date of termination. 1.2 Equal Employment Opportunity, No Discrimination. During the performance of this Agreement, the CONTRACTOR agrees as follows: a) The contractor will not discriminate against any employee or applicant for employment because of race, color, religion, sex; sexual orientation, gender identity, or national origin. The contractor will take affirmative action to ensure that applicants are employed, and that employees are treated during employment, without regard to their race, color, religion, sex, sexual orientation, gender identity, or national origin. Such action shall include, but not be limited to the following: Employment, upgrading, demotion, or transfer, recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided by the contracting officer setting forth the provisions of this nondiscrimination clause. b) The contractor will, in all solicitations or advertisements for dmployees placed by or on behalf of the contractor, state that all qualified applicants will receive consideration for employment without regard to race, color, religion, sex,sexual orientation,gender identity,or national origin. c) The contractor will not discharge or in any other manner discriminate against any employee or•applicant for employment because such employee or applicant has inquired about, discussed, or disclosed the compensation of the employee or applicant or another employee or applicant. This provision shall not apply to instances in which an employee who has access to the compensation information of other employees or applicants as a part of such employee's essential job functions discloses the compensation of such other employees or applicants to individuals who do not otherwise have access to such information, unless such disclosure is in response to a formal complaint or charge, in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer,or is consistent with the contractor's legal duty to furnish information. d) The contractor will send to each labor union or representative of workers with which it has a collective bargaining agreement or other contract or understanding, a notice to be provided by the agency contracting officer, advising the Iabor union or workers' representative of the contractor's commitments under section 202 of Executive Order 11246 of September 24, 1965, and shall post copies of the notice in conspicuous places available to employees and applicants for employment. e) The contractor will comply with all provisions of Executive Order 11246 of September 24, 1965, and of the rules,regulations, and relevant orders of the Secretary of Labor. f) The contractor will furnish all information and reports required by Executive Order 11246 of September 24, 1965, and by the rules, regulations, and orders of the Secretary of Labor, or pursuant thereto, and will permit access to his books,records,and accounts by the contracting agency and the Secretary of Labor for purposes of investigation to ascertain compliance with such rules,regulations,and orders. g) In the event of the contractor's non-compliance with the nondiscrimination clauses of this contract or with any of such rules,regulations,or orders,this contract may be canceled, terminated or suspended in whole or in part and the contractor may be declared ineligible for further Government contracts in accordance with procedures authorized in Executive Order 11246 of September 24, 1965, and such other sanctions may be imposed and Page 8 of 13 remedies invoked as provided in Executive Order 11246 of September 24, 1965,or by rule,regulation,or order of the Secretary of Labor,or as otherwise provided by law. 1.3 OTHER FEDERAL CONTRACT REQUIREMENTS The contractor and its subcontractors must follow the provisions as set forth in Appendix II to Part 200, as amended, including but not limited to: A. Contractor agrees to comply with all applicable standards,orders or regulations issued pursuant to the Clean Air Act(42 U.S.C.7401-7671q)and the Federal.Water Pollution Control Act as amended(33 U.S.C. 1251-1387)and will reports violations to FEMA and the Regional Office of the Environmental Protection Agency(EPA). B. Debarment and Suspension(Executive Orders 12549 and 12689)—A contract award(see 2 CFR 180.220)must not be made to parties listed on the governmentwide exclusions in the System for Award Management(SAM),in accordance with the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549(3 CFR part 1986 Comp.,p. 189)and 12689(3 CFR part 1989 Comp.,p.235),"Debarment and Suspension."SAM Exclusions contains the names of parties debarred,suspended, or otherwise excluded by agencies,as well as parties declared ineligible under statutory or regulatory authority other than Executive Order 12549. . C. Americans with Disabilities Act of 1990(ADA)—The Contractor will comply with all the requirements as imposed by the ADA,the regulations of the Federal government issued thereunder,and the assurance by the Contractor pursuant thereto. D. Disadvantaged Business Enterprise(DBE)Policy and Obligation-It is the policy of the County that DBE's,as defined in 49 C.F.R.Part 26,as amended,shall have the opportunity to participate in the performance of contracts financed in whole or in part with County funds under this Agreement.The DBE requirements of applicable federal and state laws and regulations apply to this Agreement.The County and its Contractor agree to ensure that DBE's have the opportunity to participate in the performance of this Agreement.In this regard,all recipients and contractors shall take all necessary and reasonable steps in accordance with applicable federal and state laws and regulations to ensure that the DBE's have the opportunity to compete for and perform contracts.The County and the Contractor and subcontractors shall not discriminate on the basis of race,color,national origin or sex in the award and performance of contracts, entered pursuant to this Agreement. E. The Contractor shall utilize the U.S.Department of Homeland Security's E-Verify system to verify the employment eligibility of all new employees hired by the Contractor during the term of the Contract and shall expressly require any subcontractors performing work or providing services pursuant to the Contract to likewise utilize the U.S. Department of Homeland Security's E-Verify system to verify the employment eligibility of all new employees hired by the subcontractor during the Contract term. F. The Contractor shall maintain a drug-free workplace in compliance with federal and state(Florida)law. G. HIPAA: The Contractor agrees to comply with the provisions of the Health Insurance Portability and Accountability Act of 1996,related regulations, as amended("HIPAA") in the event District receives patient records or information(Protected Health Information as defined by HIPAA). The Contractor's obligations under this sub-part shall survive the expiration or termination of this Agreement regardless of the reason for such termination. H. Each party shall comply with the Federal Health Care Programs' Anti-Kickback Statute(42 U.S.C. § 1320a-7b) and any applicable regulations promulgated thereunder.The parties further recognize that this Agreement shall be subject to the amendments of the Anti-Kickback Statute or any of its applicable regulations.In the event any applicable provisions of the Anti-Kickback Statutes or its regulations invalidate or are otherwise inconsistent with the terms of this Agreement or would cause one or both of the parties to be in violation of the law,the parties shall exercise their best efforts to accommodate the terms and intent of this Agreement to the greatest extent possible consistent with the requirements of the Statute and its applicable regulations. 1.4 Florida Public Records Requirements: . Pursuant to F.S. 119.0701 and the terms and conditions of this contract, the Contractor is required to: (1) Keep and maintain public records that would be required by the County to perform the service. Page 9 of 13 (2) Upon receipt from the County's custodian of records, provide the County 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 this chapter or as otherwise provided by law. (3) 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 County. (4) Upon completion of the contract,transfer, at no cost,to the County all public records in possession of the Contractor or keep and maintain public records that would be required by the County to perform the service. If the Contractor transfers all public records to the County 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 the County, upon request from the County's custodian of records, in a format that is compatible with the information technology systems of the County. (5) A request to inspect or copy public records relating to a County contract must be made directly to the County, but if the County does not possess the requested records,the County shall immediately notify the Contractor of the request, and the Contractor must provide the records to the County or allow the records to be inspected or copied within a reasonable time. If the Contractor does not comply with the County's request for records,the County shall enforce the public records contract provisions in accordance with the contract, notwithstanding the County's option and right to unilaterally cancel this contract upon violation of this provision by the Contractor. A Contractor who fails to provide the public records to the County or pursuant to a valid public records request within a reasonable time may be subject to penalties under section119.10, Florida Statutes. The Contractor shall not transfer custody, release, alter, destroy or otherwise dispose of any public records unless or otherwise provided in this provision or as otherwise provided by law. 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 PHONE# 305-292-3470 BRADLEY- BRIAN@MONROECOUNTY-FL.GOV, MONROE COUNTY ATTORNEY'S OFFICE 1111 12TH Street, SUITE 408, KEY WEST, FL 33040. Page 10 of 13 Attachment C Insurance Coverages GENERAL LIABILITY INSURANCE REQUIREMENTS: Prior to the commencement of work governed by this contract, the Contractor will obtain Commercial General Liability Insurance_ Coverage will be maintained throughout the life of the contract and include,as a rinirnum: • Premises Operations • Products and Completed Operations • Blanket Contractual Liability • Personal Injmy Liability The minimum limits acceptable is: $1,000,000 Combined Single Limit(CSL) An Occurrence Form policy is preferred. If coverage is provided on a Claims Made policy, its provisions should include coverage for claims filed on or after the effective date of this contract_ In addition,,the period for which claims may be reported should extend for a minimum of twelve ` (12)months following the acceptance of work by the County. The Monroe County Board of County Commissioners will be named as Additional Insured on all policies issued to satisfy,„ie above requirements_ MEDICAL PROFESSIONAL LIABILITY INSURANCE REQUIREMENTS: Recogni7ing that the work governed by this contract involves the providing of professional medical treatment,the Contractor will purchase and maintain, throughout the life of the contract, Professional Liability Insurance which will respond to the rendering of or failure to render medical professional services raider this contract. The minimum limits of liability are: $1,000,000 per Occurrencel$3,000,000 Aggregate If coverage is provided on a claims made basis, an extended_claims reporting period of four (4) years will be required. • Page 11 of 13 BUSINESS AUTOMOBILE LIABILITY INSURANCE REQUIREMENTS: Recognizing that the work governed by this contract requires the use of vehicles, the Contractor, prior to the commencement of work, shall obtain Business Automobile Liability Insurance. Coverage will be maintained throughout the life of the contract and include,as a minimum,liability coverage for: • Owned,Non-Owned, and Hired Vehicles The minimum limits acceptable is: $1,000,000 Combined Single Limit(CSL) If split limits are provided, the minimum limits acceptable are: $ 500,000 per Person $1,000,000 per Occurrence $ 100,000 Property Damage The Monroe County Board of County Commissioners will be named as Additional Insured on all policies issued to satisfy the above requirements. Page 12 of 13 WORKERS' COMPENSATION INSURANCE REQUIREMENTS: Prior to the commencement ofwork governed by this contract,the Contractorwill obtain Workers' Compensation Insurance with limits sufficient to respond to applicable Workers' Compensation state statutes and the'requirements of Chapter 440,Florida Statute& In addition,the Contractor will obtain Employers' Liability Insurance with limits of not less Tan- $1.00,000 Bodily Injury by Accident $500,000 Bodily Injury by Disease,policy limits $100,000 Bodily Injury by Disease,each employee Coverage will be maintained throughout the entire term of the contract Coverage will be provided by a company or companies authorized to transact business in the State of Plorida If the Contractor has been approved by the Florida's Department of Labor,as an authorized self- insurer, the County may recoa�i7e and honor the Contractor's status_ The Contractor may be required to submit a Letter of Authorization issued by the Department of Labor and a Certificate of Insurance,providing details on the Contractor's Excess Insurance Prop-am. If the Contractor participates in a self-insurance fund,a Certificate of Insurance will be required- In addition,the Contractor may be required to submit updated financial statements from the fund upon request from the County. Page 13 of 13 ,yaJS 9 U_ 1 a. ` DATE(MM/DDIYYYYI A I CERTIFICATE OF LIABILITY' INSURANCE 10/31/2018 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 POUCIES 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 pollcy(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 Ileu of such endorsement(s). PRODUCER CONTACT NAME: Willis of Seattle, Inc. PHONE FAX c/o 26 Century Blvd EMI: 1-877-945-7378 (tUc,Nole 1-BBB-d67-2378 P.O. Box 305191 MAR certificateeowillia-com ADDRESS; Nashville, TN 372305191 USA INSURER(S)AFFOROINGCOVERAGE _ NAICN INSURER A: Coverys Specialty Insurance Company 15686 INSURED INSURERS: Greenwich Insurance Company I 22322 Polak Southeast II, Corp. dime American Ambulance Services 6605 NH 74th Ave ,INSURER C: Steadfast Insurance Company I 26387 Miami, FL 33166 INSURERO: XL Specialty Insurance Company I 37885 INSURER E: I INSURER F: I COVERAGES CERTIFICATE NUMBER:W8723435 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. iNR _.--ToDC scra, — . __ —... — POLICY EPP I POLICY EX P ._..__._ TYPE OF INSURANCE IINSD,INVD; POLICY NUMBER IimooIYYYYE:IMM,TJOirvyiI UMITS X__I COMMERCIAL GENERAL LIABILITY i 1,000,000 f �PREMISES E®CE.TO oFeamance: S _ :00 CLAIMS MADE OCCUR50,0 A X Products-Claims Made 00, Y 5-10013 1C/01/201e 10/Ol/2019 PERSONALS DV INJURY IS Wv1,000 0 00 GEML AGGREGATE LIMIT APPLIESPER I GENERAL AGGREGATE S 2,000,000 X POLICY l�_1 PR CT D Li LOC PRODUCTS-COMPIOP AGG I S 2,000,000 iOTHER. "" 5 AUTOMOBILE UABIUTY 1 lfEu eBINED151NOLE LIMIT S 1,090,000 X I ANY AUTO I BODILY INJURY(Per person} i S B ..I 01TNED ILL ',SCHEDULED Y RAD500047603 10/01/2018;10/01/2019 i BODILY INJURY(Per accidI enl S —� AUTOS ONLY ,AUTOS ' HIRED NON•OWNED 'PROPERTY DAMAGE •__,AUTOS ONLY AUTOS ONLY ;Per or.e deer,,, S S C ,I .UMBRELLA UAB I X OCCUR I j i EACH OCCURRENCE _ S 15,000,000 i X`EXCESS UAB CLAIMSMADE' I UMB5414770-05 110/01/2018 10/Ol/2019.AGGREGATE �� :S 15,000,000 DEB I I RETENTIONS _ 1 S AND 01 WORKERS EMPLOYERS' ASIUT I _X F i..__ al. ;AND I AND KERS COMPENSATION LIABILITY 1 5 TUTS (, _ D ANYPROPRIETORIPARTNERIE%ECUTIVE Y!N I EEL EACH ACCIDENT S 1,000 000. .OFFICERlMEMBEREXCLUDED? ni.NIAI RND300095503 10/01/2018 10/01/2019'-- Ifyos. 1,000,000 tory in NH) I EL DISEASE-POCCYLOMTEI S 1,000,000 'It pes.describe under DESCRIPTION OF OPERATIONS below i A I Misc Medical Professional ' 5-10013 10/01/2018 10/01/2019 Per Claim 51,000,000 Liability - Claims Made •Aggregate S2,000,000 I ;Abuse 6 Molestation 51,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If mole boatels required) This Voids and Replaces Previously Issued Certificate Dated 10/16/2018 WITH ID: W8511883. Monroe County Board of County Commissioner is included as an Additional Insured as respects to General Liability where required by written contract and Auto Liability, as required by written contract. APY R! NAGEfWER9T CERTIFICATE HOLDER_ DATE 1 .• f CANCELLATION WAIV N/ YES 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 Monroe County Board of County Commissioner 490 - 63rd St l Marathon, FT. 33050 -'(% ©1986-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD cA •_D: 16996733 eATCII: 935729 ^ Page 1 of 2 / 7 DATE(MM/DD/YYYY) A o CERTIFICATE OF LIABILITY INSURANCE 12/09/2019 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 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: ' Willis of Seattle, Inc. PHONE FAX c/o 26 Century Blvd fA/C.No.Ext): 1-877-945-7378 (A/C,No): 1-888-467-2378 P.O. Box 305191 ADDRESS: certificates@willis.com Nashville, TN 372305191 USA INSURER(S)AFFORDINGCOVERAGE NAICS INSURER A: Coverys Specialty Insurance Company 15686 INSURED INSURERS: Greenwich. Insurance Company 22322 Feick Southeast II, Corp. dba American Ambulance Services 6605 NW 74th Ave INSURERC: Steadfast Insurance Company 26387 Miami, FL 33166 INSURERD: X' Insurance America Inc 24554 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:W14119252 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 ADDLTYPE OF INSURANCE INSD SUER POLICY NUMBER (MMIDDY/YYYY) (EFF MMI POLICY LIMITS LTR INSD MD X COMMERCIALGENERALLIABILITY EACH OCCURRENCE $ _1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 50,000 A X Products-Claims Made MED EXP(Any one person) $ 5,000 Y 005CA000027739I �00jj 10/01/2019 10/01/2020 PERSONAL BADVINJURY $ 1,000,000 ApE GEN'L AGGREGATE LIMIT APPLIES PER: AQ�I��i Y R S �fl '1 GENERAL AGGREGATE $ 2,000,000 X POLICY JECT PRO X LOC SO) 0 4 IIWI./1 �'fia `/n PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: DATE 1a—C�1 $ AUTOMOBILE LIABILITY E COMBINED SINGLE LIMIT $ 1,000,000 WAIVES NI� YES.___ (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED Y RAD500047604 10/01/2019 10/01/2020 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) $ C UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 1,000,000 X EXCESSLIAB CLAIMS-MADE UMB5414770-06 10/01/2019 10/01/2020 AGGREGATE $ 1,000,000 DED RETENTION$ $ WORKERS COMPENSATION X STATUTE OTH- ER AND EMPLOYERS'LIABILITY D ANYPROPRIETOR/PARTNER/EXECUTIVE YIN� N/A RWD300095504 10/01/2019 10/Ol/2020 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED7 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Misc Medical Professional 005CA000027739 10/01/2019 10/01/2020 Per Claim 1,000,000.00 Liability Aggregate 2,000,000.00 Claims Made Abuse & Molestation 1,000,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) This Voids and Replaces Previously Issued Certificate Dated 11/12/2019 WITH ID: W13813214. Aggregate limit per location only applies where required by written contract. Service compliment provided for two Advanced Life Support Units at FIU Special Needs Shelter. 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 Board of County Commissioners AUTHORIZEDREPRESENTATNE 1111 12th Street, Suite 408 7`'ui•� Key West, FL 33040 l�• / ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 18915405 BATCH: 1484360 AGENCY CUSTOMER ID: LOC#: A`� ® ADDITIONAL REMARKS SCHEDULE Page 2 of 2 .AGENCY NAMED INSURED Willis of Seattle, Inc. Falck Southeast II, Corp. dba American Ambulance Services 6605 NW 74th Ave POLICY NUMBER Miami, FL 33166 See Page 1 CARRIER NAIC CODE See Page 1 See Page 1 EFFECTIVE DATE:See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Monroe County Board of County Commissioners is included as an Additional Insured as respects to General Liability and Auto Liability, where required by written contract. i ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 18915405 HATCH: 1484360 CERT: W14119252 {C OVE Coverys Specialty Insurance Company Y l ADDITIONAL INSURED — DESIGNATED PERSON OR ORGANIZATION Attached to and forming First Named Insured: Policy Period: part of Policy Number: 005CA000027739 Falck USA,Inc. 10/1/2019 to 10/1/2020 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part SCHEDULE Name of Additional Insured Person(s)or Organization(s): All entities or organizations contracted with the Named Insured with respect to Ambulance Services rendered by the insured A. Section II. Definition of Insured is amended to include as an additional INSURED the person(s) or organization(s)shown in the Schedule above, but only with respect to liability for INJURY caused, in whole or in part, by a NAMED INSURED'S acts or omissions or the acts or omissions of those acting on a NAMED INSURED'S behalf: 1. In the performance of a NAMED INSURED'S ongoing operations; or 2. In connection with a NAMED INSURED'S premises owned by or rented to a NAMED INSURED. However: 1. The insurance afforded to such additional INSURED only applies to the extent permitted by law; and 2. If coverage provided to the additional INSURED is required by a contract or agreement, the insurance afforded to such additional INSURED will not be broader than that which a NAMED INSURED is required by the contract or agreement to provide for such additional INSURED. B. With respect to the insurance afforded to the additional INSUREDS shown in the Schedule above, if coverage provided to the additional INSURED is required by a contractor agreement,the most WE will pay on behalf of the additional INSURED is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limit of Liability shown in the DECLARATIONS; whichever is less. Nothing in this endorsement shall vary, alter,waive or extend any of the terms and conditions of the POLICY, other than as expressly stated above. , + V" 4 Gregg L. Hanson Richard G. Hayes President&CEO Treasurer Activity No.: CGL 017 07/14 Date Produced:04/20/2015 Page 1 Includes copyrighted material of Insurance Services Office,Inc.,with its permission POLICY NUMBER: RAD500047604 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s)or organization(s)who are"insureds"for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: FALCK USA, Inc. Endorsement Effective Date: October 1, 2019 SCHEDULE Name Of Person(s)Or Organization(s): Where required by written contract executed prior to loss. Information required to complete this Schedule, if not shown above,will be shown in the Declarations. Each person or organization shown in the Schedule is Autos Liability Coverage in the Business Auto and an "insured" for Covered Autos Liability Coverage, but Motor Carrier Coverage Forms and Paragraph D.2. of only to the extent that person or organization qualifies Section I — Covered Autos Coverages of the Auto as an "insured" under the Who Is An Insured provision Dealers Coverage Form. contained in Paragraph A.1. of Section II — Covered CA 20 48 10 13 ©Insurance Services Office, Inc., 2011 Page 1 of 1 ENDORSEMENT This endorsement, effective 12:01 a.m., October 1, 2019 forms a part of Policy No.RAD500047604 issued to FALCK USA, Inc. by Greenwich Insurance Company. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CANCELLATION NOTIFICATION TO OTHERS ENDORSEMENT In the event coverage is cancelled for any statutorily permitted reason,other than nonpayment of premium, advanced written notice will be mailed or delivered to person(s)or entity(ies)according to the notification schedule shown below: Number of Days Name of Person(s)or Entity(ies) Mailing Address: Advanced Notice of Cancellation: County of Monroe The Historic Gato Cigar Factory 30 Board of County Commissioners 1100 Simonton Street, Ste 205 Key West, FL 33040 All other terms and conditions of the Policy remain unchanged. (Authorized Representative) IX'405 0910 ©2010 X.L.America, Inc. All Rights Reserved. May not be copied without permission. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 57 (Ed. 12/10) ENDORSEMENT# This endorsement, effective 12:01 a.m., October 1, 2019 forms a part of Policy No.RWD3000955-04 issued to Falck USA, Inc. by XL Specialty Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CANCELLATION NOTIFICATION TO OTHERS ENDORSEMENT This endorsement modifies insurance provided under the following: WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY In the event coverage is cancelled for any statutorily permitted reason,other than nonpayment of premium, advanced written notice will be mailed or delivered to person(s)or entity(ies)according to the notification schedule shown below: Number of Days Name of Person(s)or Entity(ies) Mailing Address: Advanced Notice of Cancellation: County of Monroe The Historic Gato Cigar Factory 30 Board of County Commissioners Key West, FL 33040 All other terms and conditions of the Policy remain unchanged. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: October 1, Policy No. RWD3000955-04 Endorsement No. 2019 Insured: Falck USA, Inc. Premium: Included Insurance Company Countersigned by XL Specialty Insurance Company WC 99 06 57 Ed. 12/10 ©2010 X.L.America, Inc. All Rights Reserved. May not be copied without permission.