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Certificates of Insurance ACOR DATE(MMfDWYYY) CERTIFICATE OF LIABILITY INSURANCE 9/24/2020 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 ri hts to the certificate holder in Ileu of such endorsements. PRODUCER CONTACT NAME: PROFESSIONAL CASUALTY PHONE . 954 473-5011 472-FAJ 3982 8211 West Broward Blvd Ste 400 n®ale : dbrahm rofessionalcasuai cor .com Plantation,FL 33324-9966 INSURER(Sl AFFORDING COVERAGE NAIC ft INSURER A: Care Risk Retention Group INSURED INSURER B: Physicians Health Center INSURER C 83 36 Street INSURERD: Suite 120 INSURERE: Miami, FL 33166 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 ILA TYPE OF INSURANCE ADDL UBR POLICY NUMBER MILKY y MmmDrY EXY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ AGE T5 RENT 5 CLAIMS•AAADF E OCCUR PREMISES Ea o=rrence S MED EXP(Any oneperson' $ PERSONAL&ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER,_ GENERAL AGGREGATE S O. POLICY 0 JECT LOC PRODUCTS-COMPIOP AGG S OTHER: PSG h T $ AUTOMOBILE LIABILITY COMBINEDSINGLE LIMIT $ ANY AUTO By ''; ., - BODILY INJURY(Per person! $ OWNED SCHEDULED AUTOS ONLY AUTOS 1 �18�2 0 2 0 BODILY INJURY{Per accident) S --- ^^' HIRED NON-OWNED - `"""'""� PR PERTY DAMAGE $ AUTOS ONLY AUTOS ONLY 1 1 dJ�1 1 1 t y tlent UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS.MADE AGGREGATE S DED I I RETENTIONS $ WORKERS COMPENSATION PER DTH- AND EMPLOYERS'LIABILITY y I N STATUTE ER ANY PROPRIETORIPARTNERfEXECUTIVE = E,L EACH ACCIDENT $ OFFICER(MEMSER EXCLUDED? N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 5 Professional A Liability PPG0900002 11za2ozo 112012021 $250,000 Per Claim $750,000 Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES IACORD 101,Additional Remarks Schedule,may be attached It more space Is required) Retroactive Date 9112/2001 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Monroe County BOCC ACCORDANCE WITH THE POLICY PROVISIONS. 1111 12th Street,Suite 408 AUTHORIZED REPRESENTATIVE Key West,FL 33040 198 -2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD AC" " CERTIFICATE OF LIABILITY INSURANCE DATE(M 09/25//2020 Y) 020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND ORALTER 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 Claudia Sacasa AAI NAME: Brown&Brown Insurance Homestead Florida pAH CNN. Ext: (305)247-5121 FAX No): (305)248-8543 1780 N Krome Avenue E-MAIL csacasa@bbinsfl.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Homestead FL 33030 INSURERA: Hartford Casualty Insurance Company 29424 INSURED INSURER B: Twin City Fire Insurance Company 29459 Richard L Dolsey PHC Inc,DBA:Physicians Health Center INSURERC: OM Management,Inc. INSURER D: 4483 NW 36 Street#120 INSURER E: Miami Springs FL 33166-7260 INSURERF: COVERAGES CERTIFICATE NUMBER. 20-21 Master Liability 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 AUULbUbK POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MWDD/YYYY) (MWDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO_7TED CLAIMS-MADE �OCCUR PREM SES(Ea olccurrrence) $ 300,000 MED EXP(Any one person) $ 10,000 A Y 21 SBM T08521 05/02/2020 05/02/2021 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 X JECT LOC PRODUCTS-COMP/OPAGG $POLICY ❑ PRO 2,000,000 OTHER: Liability and Medical $ 1,000,000 AUTOMOBILE LIABILITY G�BINED SINGLE LIMIT $ 1,000,000 Ea accident ANYAUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED 21 SBM T08521 05/02/2020 05/02/2021 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED �/ NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY X AUTOS ONLY Per accident UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION X1 PER 1STATUTE EORH AND EMPLOYERS'LIABILITY Y/N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ B OFFICER/MEMBER EXCLUDED? ❑ N/A 21 WEC AH5315 O5/02/2020 O5/02/2021 (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 $ Employment Practice Liability& Aggregate 1,000,000 B Fiduciary Liability 21 HC 0338773-20 07/12/2020 07/12/2021 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is listed as additional insured with respect-r_cncral I iahilit,,hcrc by—rittor,r r,rrnrr Thic f rm is cubject to policy terms,conditions,and exclusions. ; , ' A 12 _2,9J2_Q u— WANIER _. CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Monroe County BOCC ACCORDANCE WITH THE POLICY PROVISIONS. 1111 12th Street AUTHORIZED REPRESENTATIVE Suite 408 Key West GA 33040 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD