FY1999 10/21/1998 •
AGREEMENT
This Agreement is made and entered into this Z/ day of OC1tbci-E_1998,
between the BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, hereinafter
referred to as "Board" or "County," and HOSPICE OF THE FLORIDA KEYS, INC., hereinafter
referred to as "Provider."
WHEREAS, the Board and the Provider desire to enter into an agreement wherein the
Board contracts for services from the Provider in providing the medical, psychological, physical
and social needs of terminally ill persons and their families and to mobilize other community
resources to meet such needs for the citizens of Monroe County, and
WHEREAS, such services have been provided by the Provider in the past and have
been invaluable to the citizens of Monroe County, and
WHEREAS, such services will promote independence and home care for terminally ill
persons, and
WHEREAS, the Board recognizes the public purpose to be met by an arreffnepth foci,
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services to be rendered in fiscal year 1998-99, now, therefore, ro+}c�=+' x r'-
IN CONSIDERATION of the mutual promises and covenants contains§,-lei iton
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agreed as follows: yor
-12
1. AMOUNT OF AGREEMENT. The Board, in consideration aK%ri PrZSvid
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substantially and satisfactorily performing and carrying out the duties of .carraticl.�as CD
rendering services to the citizens of Monroe County, in matters of health and educon%
regard to the care of terminally ill persons, shall pay to the Provider the sum of Forty-nine
Thousand Seven Hundred Sixty-four Dollars ($49,764.00) for fiscal year 1998-99.
2. TERM. This Agreement shall commence on October 1, 1998, and terminate
September 30, 1999, unless earlier terminated pursuant to other provisions herein.
3. PAYMENT. Payment will be paid periodically, but no more frequently than
monthly as hereinafter set forth. Reimbursement requests will be submitted to the Board via the
Clerk's Finance Office. The County shall only reimburse, subject to the funded amounts below,
those reimbursable expenses which are reviewed and approved as complying with Florida
Statutes 112.061 and Attachment A - Expense Reimbursement Requirements. Evidence of
payment by the Provider shall be in the form of a letter, summarizing the expenses, with
supporting documentation attached. The letter should contain a certification statement as
well as a notary stamp and signature. An example of a reimbursement request cover letter is
included as Attachment B.
After the Clerk of the Board examines and approves the request for reimbursement, the
Board shall reimburse the Provider. However, the total of said reimbursement expense
payments in the aggregate sum shall not exceed the total amount of $49,764.00 during the
term of this agreement.
4. SCOPE OF SERVICES.The Provider, for the consideration named, covenants and
agrees with the Board to substantially and satisfactorily perform and carry out the duties of the
Board in providing the medical, psychological, physical and social needs of terminally ill
persons and their families and shall mobilize other community resources to meet such needs for
the citizens of Monroe County, Florida. Said services shall include, but are not limited to, those
services described in Provider's Details of Specific Program for Which Funding is Requested,
attached hereto as Exhibit C and incorporated herein.
5. RECORDS. The Provider shall maintain appropriate records to insure a proper
accounting of all funds and expenditures, and shall provide a clear financial audit trail to
allow f or full accountability of funds received from said Board. Access to these records shall be
provided during weekdays, 8 a.m. to 5 p.m., upon request of the Board, the State of Florida, or
authorized agents and representatives of the Board or State.
The Provider shall be responsible for repayment of any and all audit exceptions which
are identified by the Auditor General of the State of Florida, the Clerk of Court for Monroe
County, an independent auditor, or their agents and representatives. In the event of an audit
exception, the current fiscal year contract amount or subsequent fiscal year contract amounts
shall be offset by the amount of the audit exception. In the event this agreement is not
renewed or continued in subsequent years through new or amended contracts, the Provider
shall be billed by the Board for the amount of the audit exception and the Provider shall
promptly repay any audit exception.
6. INDEMNIFICATION AND HOLD HARMLESS. The Provider covenants and agrees
to indemnify and hold harmless Monroe County Board of County Commissioners from any and
all claims for bodily injury (including death), personal injury, and properly damage (including
property owned by Monroe County) and any other losses, damages, and expenses (including
attorney's fees) which arise out of, in connection with, or by reason of services provided by the
Provider occasioned by the negligence, errors, or other wrongful act or omission of the
Provider's employees, agents, or volunteers.
7. INDEPENDENT CONTRACTOR. At all and for all purposes hereunder, the
Provider is an independent contractor and not an employee of the Board. No statement
contained in this agreement shall be construed so as to find the Provider or any of its
employees, contractors, servants or agents to be employees of the Board.
8. COMPLIANCE WITH LAW. In providing all services pursuant to this agreement,
the Provider shall abide by all statutes, ordinances, rules and regulations pertaining to or
regulating the provision of such services, including those now in effect and hereinafter
2
adopted. Any violation of said statutes, ordinances, rules and regulations shall constitute a
material breach of this agreement and shall entitle the Board to terminate this contract
immediately upon delivery of written notice of termination to the Provider.
9. COMPLIANCE WITH COUNTY GUIDELINES. The Provider demonstrate and
sustain compliance with:
(a) 501(c)(3) Registration;
(b) Board of Directors of seven or more;
(c) Annual election of Officers and Director,
id) Annual provision of annual report to County;
(e) Corporate Bylaws;
(f) Corporate Policies and Procedures Manual;
(g) Hiring policies for all staff;
(h) Cooperate with County monitoring visits; and
(I) Semi-annual performance reports to be presented to County.
9. PROFESSIONAL RESPONSIBILITY AND LICENSING. The Provider shall assure that
all professionals have current and appropriate professional licenses and professional liability
insurance coverage. Funding by the Board is contingent upon retention of appropriate local,
state and/or federal certification and/or licensure of the Provider's program and staff.
10. MODIFICATIONS AND AMENDMENTS. Any and all modifications of the services
and/or reimbursement of services shall be amended by an agreement amendment, which
must be approved in writing by the Board.
11. NO ASSIGNMENT. The Provider shall not assign this agreement except in writing
and with the prior written approval of the Board, which approval shall be subject to such
conditions and provisions as the Board may deem necessary. This agreement shall be
incorporated by reference into any assignment and any assignee shall comply with all of the
provisions herein. Unless expressly provided for therein, such approval shall in no manner or
event be deemed to impose any obligation upon the Board in addition to the total agreed
upon reimbursement amount for the services of the Provider.
12. NON-DISCRIMINATION. The Provider shall not discriminate against any person
on the basis race, creed, color, national origin, sex or sexual orientation, age, physical
handicap, or any other characteristic or aspect which is not job-related in its recruiting, hiring,
3
promoting, terminating or any other area affecting employment under this agreement. At all
times, the Provider shall comply with all applicable laws and regulations with regard to
employing the most qualified person(s) for positions under this agreement. The Provider shall
not discriminate against any person on the basis of race, creed, color, national origin, sex or
sexual orientation, age, physical handicap, financial status or any characteristic or aspect in its
providing of services.
13. AUTHORIZED SIGNATURES. The signatory for the Provider below, certifies and
warrants that:
(a) The Provider's name in this agreement is the full name as designated in its
corporate charter, if a corporation, or the full name under which the Provider is authorized to
do business in the State of Florida.
(b) He or she is empowered to act and contract for the Provider, and
(c) This agreement has been approved by the Board of Directors of the Provider if
the Provider is a corporation.
14. NOTICE. Any notice required or permitted under this agreement shall be in
writing and hand-delivered or mailed, postage pre-paid, by certified mail, return receipt
requested, to the other party as follows:
For Board: Louis LaTorre, Social Services Director
Monroe County Attorney and Public Service Building
310 Fleming Street 5100 College Road
Key West, FL 33040 Key West, FL 33040
For Provider:
Liz Kern, President
Hospice of the Florida Keys, Inc.
1319 William Street
Key West, Florida 33040
15. CONSENT TO JURISDICTION. This agreement shall be construed by and
governed under the laws of the State of Florida and venue for any action arising under this
agreement shall be in Monroe County, Florida.
16. NON-WAIVER.Any waiver of any breach of covenants herein contained to be
kept and performed by the Provider shall not be deemed or considered as a continuing
waiver and shall not operate to bar or prevent the Board from declaring a forfeiture for any
succeeding breach, either of the same conditions or covenants or otherwise.
4
17. AVAILABILITY OF FUNDS. If funds cannot be obtained or cannot be
continued at a level sufficient to allow for continued reimbursement of expenditures for
services specified herein, this agreement may be terminated immediately at the option of the
Board by written notice of termination delivered to the Provider. The Board shall not be
obligated to pay for any services or goods provided by the Provider after the Provider has
received written notice of termination, unless otherwise required by law.
18. PURCHASE OF PROPERTY. All property, whether real or personal, purchased
with funds provided under this agreement, shall become the property of Monroe County and
shall be accounted for pursuant to statutory requirements.
19. ENTIRE AGREEMENT. This agreement constitutes the entire agreement of the
parties hereto with respect to the subject matter hereof and supersedes any and all prior
agreeme ith respect to such subject matter between the Provider and the Board.
.IN.WITNESS WHEREOF, the parties hereto have caused these presents to be executed as
of 414vr and year first written above.
jtii
(S " ' BOARD OF COUNTY COMMISSIONERS
ATTE • AL71V1-VoLHAGE, CLERK OF MO '•E COUNTY, FLORIDA
Oyu
De uty C Mayor/Chairman
HOSPICE OF THE FLORIDA KEYS, INC.
(Federal ID No. 5-9 - .33 PLc2F )
ess �� /�� �y �r
%( :1-'rrx-- By Kilt
Witness Exe tive director
jconiihospice
APPROVED AS TO FORM
AND l SOFFICI •
ANNE ON
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SWORN STATEMENT UNDER ORDINANCE NO. 10-1990
MONROE COUNTY. FLORIDA
ETHICS CLAUSE
�/ A
at a 67 Y�Cr�chcwarrants that he/it has not employed, retained
or otherwise had act on his/its behalf any former County officer or employee in violation of
Section 2 of Ordinance no. 10-1990 or any County officer or employee in violation of
Section 3 of Ordinance No. 10-1990. For breach or violation of this provision the County
may, in its discretion, terminate this contract without liability and may also, in its discretion,
deduct from the contract 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.
>"it � Ca-0
(signature)
Date: /clot y /`
STATE OF (2-IAA-
COUNTY OF jilleA1 OE
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
yz AC/
E- A-/i L-G C) who,after first being sworn by me, affixed his/her
signature(name of individualin signing)ig�l in the space provided above on this (94
day of
Oe-r()oaz� , 19/C/
n�, r, OFFICB E.RADTKE
E
e--�` y SEAL
NOTARY PUBLIC SFATF.OF FLORIDA
NOTARY PUBLIC COMMISSION NO.CPA19277
MY COMMISSION 8%p,MAR 27'xNry
My commission expires: 3021 -7.0o1
OMB - MCP FORM #4
PUBLIC ENTITY CRIME STATEMENT
"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 a
contract to provide any goods or services to a public entity, may not submit
a bid on a contract with a public entity for the construction or repair of a
public building or public work, may not submit bids on leases of real
property to public entity, may not be awarded or perform work as a
contractor, supplier, subcontractor, or consultant under a contract with any
public entity, and may not transact business with any public entity in excess
of the threshold amount provided in Section 287.017, for CATEGORY
TWO for a period of 36 months from the date of being placed on the
convicted vendor list."
ATTACHMENT A
Expense Reimbursement Requirements
This document is intended to provide "basic" guidelines to Human Service Organizations, county
travellers, and contractual parties who have reimbursable expenses associated with Monroe
County business. These guidelines, as they relate to travel, are from Florida Statute 112.061,
which is attached for reference.
A cover letter summarizing the major line items on the reimbursable expense -equest should also
contain a certified statement such as:
I certify that the attached expenses are accurate and in agreement with the records of this
organization. Furthermore, these expenses are in compliance with this organization's contract
with the Monroe County Board of County Commissioners.
Invoices should be billed to the contracting agency. Third party payments will not be considered
for reimbursement. Remember, the expense should be paid prior to requesting a reimbursement.
Only current charges will be considered, no previous balances.
Reimbursement requests will be monitored in accordance with the level of detail in the contract.
This document should not be considered all-inclusive. The Clerk's Finance Department reserves
the right to review reimbursement requests on an individual basis. Any questions regarding these
guidelines should be directed to S$ephanie Griffiths at 305-292-3528.
Payroll:
A certified statement verifying the accuracy and authenticity of the payroll expenses.
If a Payroll Journal is provided, it should include:
Payroll Journal dates
employee name, salary, or hourly rate
hours worked during the payroll journal dates
withholdings where appropriate
check number and check amount
If a Payroll Journal is not provided the following must be listed:
check number, date, payee, check amount
support for applicable payroll taxes
Original vendor invoices must be submitted for Worker's Compensation arm 'lability insurance
coverage.
Telephone expenses:
A user log of pertinent information must be remitted: the party called, the caller, the telephone
number, the date, and the purpose of the call must be identified.
Telefax, fax, etc.:
A fax log is required. The log must define the sender, the intended recipient, the date, the number
called, and the reason for sending the fax.
Supplies,services, etc.:
For supplies or services ordered the County requires the original vendor invoice.
Rents,leases, etc.:
A copy of the rental agreement or lease is required. Deposits and advance payments will not be
allowable expenses.
Postage, overnight deliveries, courier, etc.:
A log of all postage expenses as it relates to the County contract is required for reimbursement.
-For overnight or express deliveries, the original vendor invoice must be included.
Reproductions, copies, etc.:
A log of copy expenses as it relates to the County contract is required for rr imbursement. The
log must define the date, number of copies made, source document, purpose, and -ecipient. A
reasonable fee for copy expenses will be allowable. For vendor services, the original vendor
invoice is required and a sample of the finished product.
Travel expenses: please refer to Florida Statute 112.061.
Travel expenses must be submitted on a State of Florida Voucher for Reimt irsement of
Travel Expenses. Credit card statements are not acceptable documentation for r .m. rrsement.
Airfare reimbursement requires the original passenger receipt portion of the airline ticket. A
travel itinerary is appreciated to facilitate the audit trail.
Auto rental reimbursement requires the original vendor invoice. Fuel purchases should be
documented with original paid receipts.
Original taxi receipts should be provided. However, reasonable fares will be reimbursed without
receipts. Taxis are not reimbursed if taken to arrive at a departure point: for exa:. ale, taking a
taxi from one's residence to the airport for a business trip is not reimbursable. ,
•
Original toll receipts should be provided. However, reasonable tolls will be reimbursed without
receipts.
Parking is considered a reimbursable travel expense at the destination. Airport parking during a
business trip is not.
Lodging reimbursement requires a detail listing of charges. The original lodging invoice must be
submitted. The County will only reimburse the actual room and related bed tax. Room service,
movies, and personal telephone calls (see previous guidelines) are not allowable expenses. Per
diem lodging expenses may apply. Again, refer to Florida Statute 112.061.
Meal reimbursement is breakfast at $3.00, lunch at $6.00, and dinner at $12.00. Meal guidelines
are that travel must begin prior to 6 am for breakfast reimbursement, before noon and end after
2pm for lunch reimbursement, and before 6pm and end after 8 pm for dinner reimbursement.
Mileage reimbursement is calculated at 20 cents per mile for personal auto mileage while on
, county business. Effective October 1, 1994, mileage will be reimbursed at 25 cents per mile. An
fq odometer reading must be included on the state travel voucher for vicinity travel. A mileage map
is attached for reference to allowable miles from various Florida destinations.
Mileage is not allowed from a residence or office to a point of departure: for example, driving
from ones home to the airport for a business trip is not a reimbursable expense.
Data processing, PC time, etc.:
I
The original vendor invoice is required for reimbursement. Intercompany allocations are not
considered reimbursable expenditures unless appropriate payroll journals for the charging
department (see Payroll above) are attached and certified.
The following expenses are not allowable for reimbursement:
penalties and fines
non-sufficient check charges
fundraising
contributions
capital outlay expenditures (unless specifically included in the contract)
depreciation expenses (unless specifically included in the contract)
SGRIFFITUS
WP 5 I\PROCEDUR\EXP REIM
ATTACHMENT B
HUMAN SERVICE ORGANIZATION LETTERHEAD
Monroe County Board of County Commissioners
Finance Department
500 Whitehead Street
Key West, Florida 33040
(Date)
The following is a summary of the expenses for (Human Service Organizationt for the time
period of to
Check # Payee Reason Amount
101 A Company rent $xxxx.xx
102 B Company utilities $xxxxx.xc
103 D Company phones $xxxx.xx
104 Person A payroll $xxrx.xx
105 Person B payroll $xx cx.xx
(A) Total Sxxxx xx
(B) Total priorfpayments $xxxx.xx
(C) Total requested and paid (A+ B) $xxxx.xx
(D) Total contract amount Sxxxx.xx
Balance of contract (D - C) fxxx21.x2c
I certify that the above checks have been submitted to the vendors as noted and that the expenses
are accurate and in agreement with the records of this organization. Furthermore, these expenses
are in compliance with this organization's contract with the Monroe County Board of County
Commissioners and will not be submitted for reimbursement to any other funding source.
Executive Director
Attachments (supporting documentation)
Sworn and subscribed before me this _day of 199 .
Notary Public Notary Stamp
C
APPLICATION FOR FUNDING
MONROE COUNTY
Through Human Services Advisory Board
October 1, 1998 - September 30, 1999
AGENCY PROFILE
Agency Name: Hospice of the Florida Keys, Inc. Agency n,,.,atee1911118 1985
Agency Location: 1319 William Street, Key West, FL 33040
Mailing Address: 1319 William Street, Key West, FL 33090
Contact: Liz Kern (Title:
CEO
Agency Phone: 305/294-8812 Fax: 315/292 9 66
Have you ever applied with Monroe County Human Services for Funding Assistance? M Yes ---
County funds be used for What is the ratio of match to Federal
Match? and/or State dollars? TOTAL NUMBER OF EMPLOYEES
YES x NO FEDERAL N/A STATE N/A
FULL PART
TIME 51 TIME 30
Is Funding for AMOUNT REQUESTED AMOUNT RECEIVED AMOUNT RECEIVED FOR
NEW FOR FOR FY 96/97
x EXISTING FY 98/99 FY 97/98
Program?
$50,000 * $50,000 $50,000
CERTIFICATION & AUTHORIZATION
This certifies that this request for funding is consistent with our organization's Articles of Incorporation and Bylaws
and has been approved by a majority of the Board of Directors.
We affirm that the Agency will use Monroe County funds for its announced purposed as submitted in its Application
for Funding. Any change will require written approval from the Monroe County Board of County Commissioners.
Contact the Office of Management and Budget at 292-4472.
We understand that the agency must meet the Eligibility Criteria to be considered for Monroe County funding and that
any applicable attachments not included disqualify the agency's application.
We further understand that meeting the Eligibility Criteria in no way ensures that the agency will be recommended for
funding by the Human Services Advisory Board. These recommendations are determined by service needs of the
community and availability of funds. Approval for funding is granted by the Monroe County Board of County
farm,.igcinnerc
\---/q, 7/C1A-4T-- )* tkl, 0-1-
Signature Signature
Liz Kern, CEO Matthew Helmerich, President
Typed Name of Executive Director Typed Name of Board President/Chairman
June 18, 1998 June 18, 1998
Date Date
* As in all prior years, the funds requested will continue to be used toward salaries
paid and FICA for nurses and home care aides who provide direct care to patients with
life limiting illnesses. These services are for care to all patients in need, including
the indigent. Indiaent care is compensated in part or in total by donations, grants or
bequests. No Monroe County resident has been denied care due to inability to pay for
needed services.
CERTIFICATE OF INSURANCE DATE: 3/31/98
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION COMPANIES AFFORDING COVERAGE
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE COMPANY A: Legion Insurance Company
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR COMPANY B:
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P(�CER 31- INSURED
NI1�Insurance Agency, Inc. VNA& Hospice of the Florida Keys
P.O. Box 988 1319 Williams Street
St. Helena, CA 94574 Key West, FL 33040
Coverages
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. i
CO EFFECTIVE EXPIRATION ✓
LTR TYPE OF INSURANCE POLICY# DATE DATE LIMITS
A GENERAL LIABILITY PL4-000870 03/10/98 03/10/99 BI&PD COMBINED
X COMP.FORM-Claims Made SINGLE LIMITS OCC $1,000,000.
PREMISES/OPERATIONS BI&PD COMBINED
CONTRACTUAL-LIMITED SINGLE LIMITS AGG $3,000,000.
B.F.PROPERTY DAMAGE PERSONAL INJ AGG P1,000.000.
A AUTO LIABILITY PL4-000870 03/10/98 03/10/99 BI&PD COMBINED
SINGLE LIMIT OCC $1,000,000.
X HIRED AUTOS
X NON-OWNED AUTOS
EXt.ESS LIABILITY
UMBRELLA FORM EA.OCCURRENCE $
OTHER THAN AGGREGATE $
A OTHER
X MEDICAL PROF. PL4-000870 03/10/98 03/10/99 BI&PD COMBINED
LIABILITY-CLAIMS MADE SINGLE LIMIT OCC $1000000.
BI&PD COMBINED
SINGLE LIMIT AGG $3,000,000.
lir PTION OF OPERATIONS
HOSPICE AND HOME HEALTH
The certificate holder named below is added as additional insured
but only with respect to hospice and/or home health actMties. APPPO B S AI:PMFMT (n'^/,/^(
ChRIIH4AIE HOLDER PY .� 'm''"/�� VJJ
Monroe County Board of County Commission 14 C/ vQQQ,,,,,,aao
Wng II #207 nATF. ` 17 �(' CG
P.S.B. 5100, College Rd
Key West, FL 33040 1hh'i!cB: NVA_._Ws
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING
COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED ABOVE, BUT FAILURE TO
MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENT,OR
REPRESENTATIVES.
AUTHORIZED-REPRESENTATIVE:
uemert.tpl
ACORU CERTIFICATE OF LIABILITY INSURANCE CSR TR4 DATE(MM/°D""
HOSPI-2 08/14/98
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Wilson, Washburn 6 Forster ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Insurance HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
10301 So. Dixie Hwy. Ste. 300 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Pinecrest FL 33156-3151 COMPANIES AFFORDING COVERAGE
Walter D. Wilson COMPANY
PBoneNo. 305-666-6636 Fax No. 305-662-7778 A Zenith Insurance Company
INSURED COMPANY
B
Hospice Of Fla. Keys Dba COMPANY
•
Visiting Nurses Assoc. ,, i C
1319 William Street COMPANY
Key West FL 33040 - D
COVERAGES
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.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICYEXPIRAT1ON LIMITS
LTR DATE(MOVODIYV) DATE(MMTMYY)
GENERAL LIABILITY GENERAL AGGREGATE $
COMMERCIAL GENERAL LIABILITY PRODUCTS•COMP/OP AGG $
CLAIMS MADE OCCUR PERSONAL&ADV INJURY $
OWNER'S B CONTRACTOR'S PROT EACH OCCURRENCE $
,r ,. FIRE DAMAGE(Any one Tire) $
MED OP(Anyone person) $
AUTOMOBILE LIABILITY ' dI I, I
COMBINED SINGLE LIMIT $
ANY AUTO
Y
— EA
OWNED AUTOS .)- NOVEC �^f ISN N 1GEM:'D BODILY INJURY $
SCHEDULED AUTOS \1i 1AI/ R/�I/ Per Person)
HIRED AUTOS ' BODILY INJURY
NON-OWNED AU Iu$ {Peraccla.m) $
DATE 21,2219g
PROPERTY DAMAGE $
4. I I" Y S
GARAGE LIABILITY ONLY.EA ACCIDENT $
ANY AUTO OTHER THAN AUTO ONLY
EACH ACCIDENT $
�'q"qfj,\� /Iryl AGGREGATE $
EXCESS LIABILITY U r � �p EACH OCCURRENCE $
UMBRELLA FORM C( (' "' AGGREGATE $
OTHER THAN UMBRELLA FORM �F J,LJZ ' $
WORKERS COMPENSATION AND +•c X TORYLI WC IT OTH-
TORYLIMNS ER <.. .
EMPLOYERS LABILITY IEL EACH ACCIDENT 3100,000.
THE PROPRIETOR/
A 1 INCL 08257 07/01/98 07/01/99 EL OISEasE.POLICY LIMIT i500 r000.
OFF ERSIE%ECUTIVE
OFFICERS ARE EXCL EL DISEASE EAEMPLOYEE E1DD,DDD.
OTHER
DESCRIPTION OF OPERATIONSIOCATONSNEHICLES/SPECIAL ITEMS
CERTIFICATE HOLDER ;, CANCELLATION
HOSPICE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Hospice of the Florida Keys. , EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
Hospice of the Florida Keys 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
DHA Visiting Nurses Associatin BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
1319 William Street ry�
Key West FL 33040 L� OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES
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DAT falter D. Wilson j4)C2 $UG__1_ It)' eir
ACORD25-S(1/95) ACORDCORPORATION1988
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