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Certificates of Insurancea' C UNTY o MON ROE KEY WEST FLORIDA 33040 (305)294-4641 Monroe County Risk Management Wing II, Room 207 P.S.B. 5100 College Road Key West, FL 33040 May 7, 1993 Mr. Walter D. Wilson Wilson, Washburn & Forster Insurance P.O. Box 5250 Hialeah, FL 33014 BOARD OF COUNTY COMMISSIONERS MAYOR, Jack London, District 2 Mayor Pro Tem, A Earl Cheal, District 4 Wilhelmina Harvey, District 1 Shirley Freeman, District 3 Mary Kay Reich, District 5 Re: Insurance Certificate -Hospice of the Florida Keys, Inc. dba: Visiting Nurse Assoc. Policy # FK 06801617 Dear Mr. Wilson: Enclosed please find a copy of the Certificate of Insurance for- warded to the Risk Management office for subject policy on 12/29/92 and the Certificate forwarded on 5/5/93. Also enclosed is a letter to Hospice requesting the addition of Monroe County Board of County Commissioners as Additional Insured to the Cer- tificate issued on 4/15/93. Note that the re -issued Certificate does not contain the verbage requested. Please forward a corrected Certificate to the Risk Management office as soon as possible that contains the Additional Insured requirement. If you have any questions, please call me at 292-4542. Sincerely, �J Kay BZieda Risk Management cc: Hospice of the Florida Keys, Inc. Beth Leto LEWW&F/txtbahl /�4i401:0. ULK I INUA I t Ulf- MUMMA: 5/ 5/ 9 3 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE WILSON, WASHBURN & FORSTER INS. POLICIES BELOW. P. 0. BOX 5250 COMPANIES AFFORDING COVERAGE HIALEAH? FLORIDA 33014 COMPAN LETTER Y A ST. PAUL FIRE & MARINE INS CO. INSURED COMPANY B LETTER HOSPICE OF THE FLORIDA KEYS, INC. LE° TERNY c dba: VISITING NURSE ASSOC. OF ,COTHE FLORIDA KEYS LETT R"Y D P. 0. BOX 6558 COPAN KWY WEST, FLORIDA 33041 LETTER Y E CQVERA0 8 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 REOUIREMENT, 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 POLICII-S DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEErj REDUCED BY PAID CLAD4S. CO TYPE OF INSURANCE 0 LTR• POLICY NUMBER i GENERAL LIABILITY XXCOMMERCIAL GENERAL LIABILITY CLAIMS MADE ��' OCCUR. FK 06801617 OWNER'S &CONTRACTOR'S PROT. AVTOM091LE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS GARAGE LIABILITY EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION AND EMPLOYERS' LIABILITY OTHER PROFESSIONAL FK 06801617 CLA DESCRIPTION OF OPERATIONS/LOCATIONB/VENICLES/SPECIAL ITEMS POLICY EFFECTIVE POLICY EXPIRATI N LIMITS DATE (MM/DD/YY) DATE (MM/DDIYY) ~ GENERAL AGGREGATE $ Z, 0 0 0, 0 0 0 PRODUCTS-COMP/OP AGG. $ 2, 0 0 0, 0 0 0 PERSONAL 6 ADV. INJURY S1,0001000 3/10/93 3/10/94FACHOGCURRENCE $1,000,000 FIRE DAMAGE (Any one ti•o) a 1, 0 0 0, 0 0 0 MED. EXPENSE (Any one person) S 5 n 0 0 COMBINED SINGLE 6 LIMIT BODILY INJURY _ (Per Person) BODILY INJURY s (Par accident) PROPERTY DAMAGE 3 _ EACH OCCURRENCE S AGGREGATE _ STAIUIORY LIMITS, EACH ACCIDENT , S DISEASE —POLICY LIMIT S DISEASE —EACH EMPLOYEE 3 $1,000,000. EACH PERSON!. 3/10/93 3/10/94 $3,000,000. TOTAL LIMIT. RETRO DATE 3/10/88 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE MONROE COUNTY BOARD OF COUNTY EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TOi COMMISSION, WING 11, # Z 07 MAIL 4 5 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE! P.S.B. 5100, COLLEGE ROAD LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION ORE KEY WEST, FLORIDA 33040 ik►1ILfTY.OF•AraY.K(ND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. *1ITN� RlgRESENT" E W.�LT WILSON PRODUCER Wilson, Washburn & Forster Insurance P. O. Box 5250` Hialeah FL 33014 Walter D. Wilson 305-591-8110 INSURED Hospice Of the Florida Keys., Hospice of the Florida Keys., dba Visiting Nurses Association 1319 William Street Key West FL 33040 F1 N S U RAN C E Tit ISSUE DATE IMM/DD/YYI 02/24/94 OSPI-2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY A St. LETTER Pahl Fire & Marine Ins. APPROVED BY RISK MANAGEMENT COMPANY B LETTER BY_�2& COMPANY LETTER C DATE COMPANY LETTER D WAIVER: _ N/A COMPANY E LETTER I. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, P.01T:A.11THSTANDING ANY REQUIRFMFNT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS I 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 - POLICY EXPIRATION LIMITS LTR; DATE(MM/DD/YY) DATE (MM/DD/YY) GENERAL LIABILITY GENERAL AGGREGATE $2 , 000, 000 . A g COMMERCIAL GENERAL LIABILITY Fk06801617 03/10/94 ' 03/10/95 :PROD UCTS-COMP/OP AGG. $---------- :. CLAIMS MADE ,_ X : OCCUR. :PERSONAL & ADV. INJURY $1, 000, 000 . OWNER'S & CONTRACTOR'S PROT. EACH OCCURRENCE $1 , 000 , 000 . FIRE DAMAGE (Any one fire) $1, 000, 000 . MED. EXPENSE (Any one person) S 5,000. AUTOMOBILE LIABILITY COMBINED SINGLE ANY AUTO LIMIT $ ALL OWNED AUTOS SCHEDULED AUTOS i _ r BODILY INJURY (Per person) $ D _... _........ HIRED AUTOS - BODILY INJURY NON -OWNED AUTOS : (Per accident) $ GARAGE LIABILITY PROPERTY DAMAGE : $ EXCESS LIABILITY EACH OCCURRENCE S Received UMBRELLA FORM AGGREGATE $ Risk Mgmt. & Loss Control OTHER THAN UMBRELLA FORM WukKC i'S Liirvirv:e.ii50i: - DATE -- V —��/ �� : STATUTORY LIMITS � I AND l /SL /� b EACH ACCIDENT EMPLOYERS' LIABILITY DISEASE —POLICY LIMIT S - DISEASE— EACH EMPLOYEE - S OTHER A Prof. Liab. FK 06801617 03/10/94 03/10/95 Each Prs 1,000,000. ;Claims Made Policy Retro Date 3/10/88 Total Lmt 3,000,000. DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS Certificate Holder Named As Additional Insured as respects to insured's operations. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE Monroe County Board of County LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR Commission, Wing II, #207 LIABILITY OF ANY KIND UPON THE CO PANY, ITS AGENTS OR REPRESENTATIVES. P.S.B. 5100, College Road Key West FL 33040 AUTHORIZED REPRESENTATIVE A4A `,�/�-�r+.� RRT pX A' //�` 1,01M. V E R # I FI C T O l! ■ RA V � CSR TM DATE IMMIDDIYYI H©SP�-2 04/10/97 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Wilson, Washburn & Forster ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 7050 N.W. 77th Court ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Miami FL 33166-2785 COMPANIES AFFORDING COVERAGE Walter D. Wilson PnoneNo. 305-591-8110 Fax No. COMPANY A RISCORP Insurance Company INSURED COMPANY B St. Paul Fire & Marine Ins. Hospice of the Florida Keys COMPANY Inc. DBA Visiting Nurses Asso. of the Florida Keys C , 1319 William Street Key West FL 33040 COMPANY 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 LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION �DATE(MMIDDNYI LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ 3, 000, 000. X PRODUCTS - COMP/OPAGG 53,000,000, B COMMERCIAL GENERAL LIABILITY FK06804760 03/10/97 03/10/98 CLAIMS MADE Ex_] OCCUR PERSONAL & ADV INJURY $ 1, 000, 000. EACH OCCURRENCE $ 1, 000, 000. OWNER'S & CONTRACTOR'S PROT FIRE DAMAGE (Any one fire) $ 50,000. M ED EXP (Any one person) $ 51000. AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS PROVED ISINIAGWINT BY I DATE - WAIVFR: N/A v YFS CC'' Qr,0,6 %�, �) C�,/Uy �{p'O�_" e V COMBINED SINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: ANY AUTO EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ AGGREGATE $ UMBRELLA FORM $ OTHER THAN UMBRELLA FORM A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY STATUTORY LIMITS EACH ACCIDENT $ 100, 000 . THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE 08257 07/01/96 07/01/97 DISEASE -POLICY LIMIT $500,000. DISEASE- EACH EMPLOYEE $ 100, 000 . OFFICERS ARE: EXCL OTHER B Professional Liab. FK06804760 03/10/97 03/10/98 Ech Occr. 1,000,000. Claim -Made Policy T1 Limit 3,000,000. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS Certificate Holder Named As Additional Insured as respects to insured's operations. CERTIFICATE HOLDER CANCELLATION MONROEC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL Monroe County Board of County Commission, Wing II, #207 P.S.B. 5100, College Road 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Key West FL 33040 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. ._ AUTHORIZED REPRESENTATIVE II ♦♦�� Walter D. Wilson k)4A�( h, AGORb 25-S (3/93) ©ACORD CORPORATION 1993 DATEIMM/DD/YYI CERTIFICATE OFF INSURANCE CSR TM 1I0SPI-2 10/28/97 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Wilson, Washburn & 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 Phone No. 305-666-6636 Fax No. COMPANY A RISCORP Insurance Company INSURED j J COMPANY B St. Paul Fire & Marine Ins. Hospice of the Florida Keys COMPANY Inc. DBA Visiting Nurses Asso. of the Florida Keys 1319 William Street Key West FL 33040 C COMPANY D CCVERACES 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 LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE S 3,000,000. B X COMMERCIAL GENERAL LIABILITY FK06804760 03/10/97 03/10/98 PRODUCTS - COMP/OPAGG S3,000,000, CLAIMS MADE I —XI OCCUR PERSONAL & ADV INJURY S 1,000,000. EACH OCCURRENCE S 1,000,000. OWNER'S & CONTRACTOR'S PROT FIRE DAMAGE (Any one fire) $ 50,000. MED EXP (Any one person) $ 5,000. AUTOMOBILE LIABILITY ANY AUTO APPRO D BY K VANAG VIENT COMBINED SINGLE LIMIT $ BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BY BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS DATE / PROPERTY DAMAGE $ N/A YGS GARAGE LIABILITY (�• AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: ANY AUTO Cl✓ EACH ACCIDENT S AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ AGGREGATE $ UMBRELLA FORM $ OTHER THAN UMBRELLA FORM A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY STATUTORY LIMITS EACH ACCIDENT $100, 000. THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE 08257 07/01/97 07/01/98 DISEASE -POLICY LIMIT $500,000. DISEASE - EACH EMPLOYEE $100, 000 . OFFICERS ARE: EXCL OTHER B Professional Liab. FK06804760 03/10/97 03/10/98 Ech Occr. 1,000,000. Claim -Made Policy T1 Limit 3,000,000. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS Certificate Holder Named As Additional Insured as respects to insured's operations. CERTIFICATE HOLDER CANCELLATION MONROEC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL Monroe County Board of County Commission, Wing 11, #2 07 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, P.S.B. 5100, College Road BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Key West FL 33040 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Walter D. Wilson AGORD 25-5 (3/93) ©ACORD CORP©RATION 1993 I' A0101H). CERTIFICATE OF INSURANCE CSR TM> DATE(MM/DD/Yy) PRODUCER HOSPI-Z 10/30/97 Wilson, Washburn & Forster THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 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 Phone No. 305-666-6636 Fax No. A RISCORP Insurance Company INSURED COMPANY Hospice of the Florida Keys B St. Paul Fire & Marine Ins. COMPANY Inc. DBA Visiting Nurses Asso. 1.) of the Florida Keys �� C 1319 William Street COMPANY D 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS DATE IMM/DDNY) DATE IMM/DD/YYI GENERAL LIABILITY GENERAL AGGREGATE s3,000,000. X B COMMERCIAL GENERAL LIABILITY FK06804760 03/10/97 03/10/98 PRODUCTS - COMP/OPAGG 53,000,000. CLAIMS MADE ®OCCUR PERSONAL & ADV INJURY $ 1, 000, 000 . OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ 1, 000, 000 . FIRE DAMAGE (Any one fire) $ 50,000. MED EXP (Any one person) $ 5 , Q Q Q , AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS APP O D ISK 'J ACTM-TNT SCHEDULED AUTOS BY BODILY INJURY (Per person) $ HIRED AUTOS NON -OWNED AUTOS DATE BODILY INJURY (Per accident) $ rit'r, l':'ER N/A ! Y S PROPERTY DAMAGE $ GARAGE LIABILITY ANY �✓" AUTO ONLY - EA ACCIDENT S AUTO j l/ OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY .: %j �dl'�,/`� EACH OCCURRENCE $ UMBRELLA FORM �n AGGREGATE $ OTHER THAN UMBRELLA FORM $ A WORKERS COMPENSATION AND STATUTORY LIMITS EMPLOYERS' LIABILITY EACH ACCIDENT 8 ZOO, OOO , THE DISEASE - POLICY LIMIT 9500,000, S/EXEPROPRIETOR/ INCL PARTNERS/EXECUTIVE PARTNERS/EXECUTIVE 0$257 Q'� 0 / 1/97 07/O1/98 OFFICERS ARE: EXCL DISEASE - EACH EMPLOYEE 5 100, 000. OTHER B Professional Liab. FK06804760 03/10/97 03/10/98 Ech Occr. 11000,000. Claim -Made Policy T1 Limit 3,000,000. DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/SPECIAL ITEMS Certificate Holder Named As Additional Insured as respects to ind' operations. sures (� NOV 03 CERTIFICATE HOLDER : CANCELLATION MONROEC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BECAFIB` EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TOM Monroe County Board of County _ 10 Commission, Wing II, #207 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, P.S.B. 5100, College Road BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Key West FL 33040 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE / A / , alter D. Wilson `/(,Q,(� J k)-J/ ACORD 25-S (3793) - j . 0 ACORD CORPORATION:1993 ACORD CERTIFICATE OF LIABILITY INSURI�NCE CSR TM DATE(MM/DDNY) PRODUCER HOSPI:^2 " 11/15/99 Wilson, Washburn & Forster THIS CERTIFICATE IS ISSUED AS A MATTER OF -IN -FORMATION Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE OR 10301 So. Dixie Hwy. Ste. 300 ALTER THEHOLDE.HCOVERAGE AFFORDED BCERTIFICATE DOESOY THE POLIC ESAMEND,END BELOW. Pinecrest FL 33156-3151 COMPANIES AFFORDING COVERAGE Walter D. Wilson COMPANY PnoneNo. 305-666-6636 Fax No. 305-662-7778 A Zenith Insurance Company(FL) INSURED COMPANY B Hospice Of Fla. Keys Dba COMPANY Visiting Nurses Assoc. C 1319 William Street Key West FL 33040 COMPANY D COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 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 EXCLUSIONS TO ALL THE TERMS, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. T TYPE OF INSURANCE LTR POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY GENERALAGGREGATE $ CLAIMS MADE E OCCUR PRODUCTS - COMP/OP All $ OWNER'S & CONTRACTOR'S PROT PERSONAL & ADV INJURY $ EACH OCCURRENCE $ FIRE DAMAGE (Any one fire) $ AUTOMOBILE LIABILITY MED EXP (Any one person) $ ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS j _ "' SCHEDULED AUTOS (1 BODILY INJURY —— -- (Per person) $ HIRED AUTOS 1' 'r 1 D. NON -OWNED AUTOS —..-_, BODILY INJURY (Per accident) $ 1 PROPERTY DAMAGE $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ cEACH OTHER THAN AUTO ONLY. ACCIDENT $ EXCESS LIABILITY AGGREGATE $ UMBRELLA FORM EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM AGGREGATE $ WORKERS COMPENSATION AND $ EMPLOYERS' LIABILITY WC STATU- OTH- TORY LIMITS ER A THE PROPRIETOR/ PARTNERS/EXECUTIVE INCL 08257 EL EACH ACCIDENT $ 100 , 000 07/01/99 07/01/00 EL DISEASE OFFICERS ARE, EXCL -POLICY LIMIT $ 500,000 OTHER EL DISEASE - EA EMPLOYEE $ 100 , 000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION MONROEC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Monroe County Board of County EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL COmmi.a. Sion, Wing 11 , #207 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, P . S . B . 5100, College Road BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Key West FL 33040 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENT&IVES. AUTHORIZED REPRESENTATIVE Walter D. ��C��o/V ACQRD25-5(1/95) ',I Wilson ✓. - ACOF;D CORPRATION 1988 A�/���•��® CERTIFICATE OF INSURANCE- DATE(MM/DD/YY) PRODUCER 07 1 1 I 1 b/ 200 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 00336 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. DOESWILSON WASHBURN & FORSTER INSURANCE ALTER THEHIS COVERAGECATE AFFORDED BYO THE POAMENLICIES BELOW. SUITE 300 COMPANIES AFFORDING COVERAGE 10301 SOUTH DIXIE HIGHWAY - i COMPANY - -- --PLNE_OkE_S_T - - - FL -- 33_!6__ A Z rc i th I to ut a:-tc C_ t pans (FL) } INSURED -- - i_ COMPANY 08257 B HOSPICE OF THE FLORIDA KEYS INC - 1319 WILLIAMS STREET COMPANY KEY WEST - -- - - - - I FL 33040-4736 COMPANY _ 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. ( )- - - i CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE I POLICY ( ) EXPIRATIONDATE LIMITS ,GENERAL LIABILITY j GENERAL AGGREGATE $ - - OCCUR - - -- CLAIMS MADE PRODUCTS-COMP/OP AGG $ { I COMMERCIAL GENERAL LIABILITY - PERSONAL & ADV INJURY $ f I OWNER'S & CONT PROT -- --- ` EACH OCCURRENCE $ - - - -- - - - r FIRE DAMAGE (Any one fire) $ - MED EXP (Any one person) $ AUTOMOBILE LIABILITY _ ' I���LLL' ANY AUTO 6T P,E COMBINED SINGLE LIMIT $ 1 ALL OWNED AUTOS -- - SCHEDULED AUTOS BODILY INJURY -- I HIRED AUTOS (Per person) $ NON -OWNED AUTOS /(� �' ' BODILY INJURY - V v 7 \� (Per accident) $ v -- G r PROPERTY DAMAGE $ j GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO -- -- -- - — -- - OTHER THAN AUTO ONLY. -- - - EACH ACCIDENT $ EXCESS LIABILITY AGGREGATE $ EACH OCCURRENCE $ UMBRELLA FORM -- AGGREGATE $ I OTHER THAN UMBRELLA FORM - - - WORKERS COMPENSATION AND $ EMPLOYERS' LIABILITY STATUTORY LIMITSA THE I INCL' e OFFICERS AIREOR/ EXCL' i? 82 r 0 7 ,/ 0 , { C (� EACH ACCIDENT $ 166 k t PARTNERS/EXECUTIVE t OQ {3 7 /C} 1 1.��� POLICY LIMIT $ �(%Q - OTHER DISEASE -EACH EMPLOYEE $ 1 Q{j k 1 DESCRIPTION OF OPERATIONS/LOCATIONSlVEHICLES/SPECIAL ITEMS — M a I MONROE COUNTY BOARD OF COUNTY COMMISSIONERS 5100 COLLEGE RD KEY WEST FL 33040 M) cANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL I DAYS WRITTEN NOTICE TO T CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOT E HALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIWIIPON THE M NY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED RE RES NTATIYE+ i 0 ACORD CORPORATION 1993 PROM CER NHPCO Insurance C/o Glatfelter Underwriting Services P.O. Box 2726 York, PA 17405 Hospice of the FL Keys, Inc & Visiting Nurse Assoc. 1319 William Street Key West, FL 33040 € .. ISSUE DATE (MMIDD/YY) 06/07/01 THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORD BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY LETTER A Great Lakes, UK COMPANY LETTER B COMPANY LETTER D INDICATED. NOTWITHSTANDING ANYREQUIREMENT, TERM OR CONDITION OF ANY CONTRI . I ME INSURED NAMED ABOVE FOR THE POLICY PERIOD ACT 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. LTR GENERAL LIABILITY A ® COMM. GENERAL LIABILITY ® CLAIMS MADE ❑ OCCUR ❑ OWNER'S & CONTRACT'S PROT. El BINC21253 ❑ANY AUTO A ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS ® HIRED AUTOS ® NON -OWNED AUTOS ❑ GARAGE LIABILITY EXCESS LIABILITY ❑ UMBRELLA FORM ❑ OTHER THAN UMBRELLA FORM WORKERS' COMPENSATION AND EMPLOYER'S LIABILITY DATE (MM/DD/YY) 3110101 3110101 t W DATE (MM/DD/YY) 3/10/02 GENERAL AGGREGATE COMBINED SINGLE $1'00 LIMIT BODILY INJURY $ (Per Person) BODILY INJURY $ (Per Accident) EACH OCCURRENCE I $ AGGREGATE S $ A Professional Liability BINC21253 3110101 3/10/02 $3,000,000 Annual Aggregate/ Claims Made $1,000,000 Each Medical Incident DESCRIPTION OF OPERATIONS/LOCATIONSNFHICLES/SPECIAL ITEMS The Certificate Holder listed below is added as an additional insured but only with respects to hospice and/or home health activities. Monroe County Board of County Commissioners Wing 11, #207 P.S.B. 51009 College Road Key West, FL 33040 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MA"O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MALL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS. AGENTS OR REPRESENTATIVES AUTHORIZED REPRESENTATIVE JE !RDF CERTIFICATE OF LIABILITY INSURANCE OP ID A3 DATE (MM/DD/YYYY) HOSPI-3 08/18/10 1PRODUCER Bouchard -Clearwater THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 101 Starcrest Drive HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P O Box 6090 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Clearwater FL 33758-6090 Phone : 727-447-6481 Fax : 727-449-1267 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: American Alternative Ins co 19720 Hospice of the Florida Keys, Inc. INSURER B: Zenith Insurance company 13269 INSURER C: Greg Wheeler 1319 William St INSURERD: Key West FL 33040-4736 INSURER E: AA• i�w � w-w vvvQrvyvQa 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR INSRIC TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION POLICY NUMBER DATE MM/DD/YYYY DATE MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1, 0 0 0, 0 0 U A X X COMMERCIAL GENERAL LIABILITY VHHHHG3 0 514 4 2 0 3 0 3/ 10 / 10 0 3/ 10 / 11 PREMISES (Ea occurence) $ 1, 0 0 0, 0 0 0 X CLAIMS MADE F—IOCCUR MED EXP (Any one person) $ 50 r 000 X Professional RETRO DATE 3/10/88 PERSONAL &ADV INJURY $ 1 r 00U r 000 GENERAL AGGREGATE $ 3, 0 0 0 r 0 O 0 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 3 , 000 OOO X POLICY PR O- JECT TLOC Emp Ben , 1, 000 , 000 AUTOMOBILE LIABILITY A X ANY AUTO COMBINED SINGLE LIMIT (Ea accident) 1 0 00 0 0 0 $ r r ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ X HIRED AUTOS VHHHHG3 0 514 4 3 / 10 / 10 0 3 / 10 / 11 X NON -OWNED AUTOS BODILY INJURY (Per accident) $ 4 PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC AUTO $ ONLY: AGG $ EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE s2,000,000 A 7 OCCUR Cl CLAIMS MADE VHHHHU505007903 03/10/10 03/10/11 AGGREGATE $ 2r r 000 000 DEDUCTIBLE $ X RETENTION $ 0 WORKERS COMPENSATION $ AND EMPLOYERS' LIABILITY Y / N X TORY LIMITS I 7ER B ANY PROPRIETOR/PARTNER/EXEC UTIV OFFICER/MEMBER EXCLUDED? Z830825719 07/01/1.0 07/01/11 E.L. EACH ACCIDENT $ 100 , 000 (Mandatory in NH) If yes, describe under E.L. DISEASE - EA EMPLOYEE $ 100,f 000 SPECIAL PROVISIONS below OTHER E.L. DISEASE -POLICY LIMIT $ rj 0 0 r 0 0 0 A DIRECTORS &OFF;ICER VHHHHD405010703 03/10/10 03/10/11 Liability 3,000,000 DED $2500 Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS 3,000,000 Certificate Holder is included as additional insured as their interest may appear as respects general and automobile liability subject to policy conditions, terms and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION MONROEC DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Monroe County IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 1100 Simonton REPRESENTATIVES. Key West FL 33040 AUTHORIZED E ENTATIVE ACORD 25 (2009/01) wo ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD cow CERTIFICATE OF LIABILITY INSURANCE OP ID A3 DATE DDNYYY) PRODUCER HOSPI-3 08 18 10 ch Bouuchard-Clearwater THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 101 s tarcres t Drive ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P O Box 6090 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Clearwater FL 33758-6090 Phone:727-447-6481 Fax:727-449-1267 INSURERS AFFORDING COVERAGE NAIL# INSURED INSURER A: American Alternative Ina Co 19720 Hospice of the Florida Keys, Inc. INSURER B: Zenith Insurance Company 13269 Greg Wheeler 1319 INSURER C: William st Rey West, FL 33040-4736 INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MOK LTR NSRC TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY ION DATE MIWDD DATE MWD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 110001000 A X X COMMERCIAL GENERAL LIABILITY VBBHHG3 051442 0 3 X CLAIMS MADE F—] OCCUR 0 3 / 10 / 10 03/10/11 Dm PREMISES (Ea occurence) $ 1, Q Q 0 , Q Q 0 MED EXP (Any one person) $ g Q Q Q Q ElX Professional RETRO DATE 3/10/88 PERSONALBADVINJURY $ 1,000,000 GENERAL AGGREGATE s3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 3,000,000 X7 POLICY F--1 Ja F-1 LOC Enp Ben 11000,000 AUTOMOBILE LIABILITY A X ANY AUTO COMBINED SINGLE LIMIT (Ea acciderd) $ 110 0 0, 0 o 0 ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ X HIRED AUTOS VBHBHG305144203 10/10 03/10/11 X NON -OWNED AUTOS BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITYVi AUTO ONLY- EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS / UMBRELLA LIABILITY A 7 OCCUR rx� CLAIMS MADE VBHHHU505007903 EACH OCCURRENCE $ 2, o 0 0, o 0 0 03/10/10 03/10/11 AGGREGATE $2,000,000 DEDUCTIBLE X RETENTION $ Q WORRERSCOMPENWION $ AND EMPLOYERS' LIABILITY Y/NTS ANY X ITORYLIMIWCSTAI PROPRIETOR/PARTNEWDCECUTIV OFFICER/MEMBER EXCLUDED? Z 8 3 0 8 2 5 719 0 7 / 01 / 10 0 7 / 01 / 11 E.L. EACH ACCIDENT $100 000 (Mandatory In NH) , If s, describe under E.L. DISEASE - EA EMPLOYEE $ 10 Q f Q Q Q SPECIAL PROVISIONS below OTHER E.L. DISEASE -POLICY LIMIT $ g Q Q Q Q Q A DIRECTORS &OFFICER VERBBD405010703 03/10/10 03/10/11 Liability3 000 00o ' ' i - DED $2500 Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS 31000,000 Certificate Holder is included as additional insured as their interest may Appear as respects general and automobile liability subject to policy conditions, terms and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION MNROEC DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3_0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Monroe County 1100 Sim nton Rey West FL 33040 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORRED E NTATNE I ACORD 25 (2009/01) 41988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD OP ID: A3 Acoizo CERTIFICATE OF LIABILITY I N S U RAN C E �.� DATE /YYYY) 03/22//22/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 727-447-6481 Bouchard -Clearwater 727-449-1267 101 Starcrest Drive P O BOX 6090 Clearwater, FL 33758-6090 ,l&T CONTACT NAME: PHONE FAX A/c No Ext : A/C No): E-MAIL PRODUCER CUSTOMER ID#: HOSPI-3 INSURERS AFFORDING COVERAGE NAIC # INSURED Hospice of the Florida Keys, INSURER A: American Alternative Ins Co 19720 Inc. INSURER B: Zenith Insurance Company 13269 Greg Wheeler 1319 William St INSURER C Key West, FL 33040-4736 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTRINSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY M% DYEFF /YYYY MMLDDY� LIMBS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X CLAIMS -MADE U OCCUR X VHHHHG3051442 03/10/11 03/10/12 DAMAGET RENTED1 PREMISES Ea occurrence $ 000,00 MED EXP (Any one person) $ 50,00 PERSONAL & ADV INJURY $ 1,000,00 X Professional RETRO DATE 3/10/88 GENERAL AGGREGATE $ 3,000,00 [EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 3,000,00 X POLICY PRO LOC Emp Ben $ 1,000,000 AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00C BODILY INJURY (Per person) $ f� ', -, ( ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS �� X 1 HIREDAUTOS - - f' VHHHHG3051442 - 03/10/11 03/10/12 PROPERTY DAMAGE (Per accident) $ X I NON -OWNED AUTOS $ $ A UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE VHHHHU5050079 03/10/11 03/10/12 EACH OCCURRENCE $ 2,000,00 X AGGREGATE $ 2,000,00 DEDUCTIBLE $ X $ RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? ❑ N / A Z830825719 07/01/10 07/01 /11 X I WC STATU- OTH- T Y I IT R E.L. EACH ACCIDENT $ 100,00 E.L. DISEASE - EA EMPLOYEE $ 100,00 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,00 A DIRECTORS &OFFICER HHHHD4050597 03/10/11 03/10/12 Liability 3,000,00 DIED $2500 Aggregate 3,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) 1.N17l,CLL/A I IVIV MONROEC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Monroe County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1100 Simonton ACCORDANCE WITH THE POLICY PROVISIONS. Key West, FL 33040 AUTHORIZED REPRESENTATIVE I U 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD OP ID: A3 CERTIFICATE OF LIABILITY INSURANCE AT06/2DDIYYYY) r6/28112 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER 727-447-6481 Bouchard -Clearwater 727-449-1267 101 Starcrest Drive P O Box 6090 Clearwater, FL 33758-6090 J&T NAME: CONTACT PHONE FAX A/C No Ext : A/C No): E-MAIL ADDRESS: PRODUCER HOSPI-3 CUSTOMER ID #: INSURERS AFFORDING COVERAGE NAIC # INSURED Hospice of the Florida Keys, INSURER A: American Alternative Ins Co 19720 INSURER B: Zenith Insurance Company 13269 Inc. Greg Wheeler 1319 William St INSURER C Key West, FL 33040-4736 INSURER D : INSURER E : INSURER F : rnV9I2ArzFc rFRTIFIr ATF Nt1MRFR- 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 LTR TYPE OF INSURANCE ADDL J= UB J80aPOLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY X CLAIMS -MADE D OCCUR X Professional X VHHHHG3051442 RETRO DATE 3/10/88 ' AP D BY 03/10/12 03/10/13 EACH OCCURRENCE $ 1,000,000. PREMISES Ea oc ur re $ 1,000,00 MED EXP (Any one person) $ 50,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 3,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- LOC PRODUCTS - COMP/OP AGG $ 3,000,00 Emp Ben $ 1,000,00 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS X `((( - VHHHHG3051442 INCLUDED IN GL LIMIT 03/10/12 03/10/13 COMBINED SINGLE LIMIT (Ea accident) $ Include BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ A UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE VHHHHU5050079 03I10112 03I10113 EACH OCCURRENCE $ 2,000,00 X AGGREGATE $ 2,000,00 DEDUCTIBLE RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, descr be under DESCRIPTION OF OPERATIONS below N / A Z830825719 07/01/12 07/01/13 X T WCRY LIMITS IMIT EERR SLIMIT E.L. EACH ACCIDENT $ 100,00 E.L. DISEASE - EA EMPLOYEE $ 100,00 E.L. DISEASE - POLICY LIMIT $ 500,00 A DIRECTORS &OFFICER VHHHHD4050597 DED $2500 03/10/12 03110/13 Liability 3,000,00 Aggregate 3,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) MONROEC Monroe County Board of County Commissioners 1100 Simonton Key West, FL 33040 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 U 1938-2009 AGORD GUKPUKAI IUN. All ngnts reservea. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD