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Certificates of InsuranceProNational the new name for PPTF CERTIFICATE OF INSURANCE TO: MCBOCC ATTN: RISK MGMT 5100 COLLEGE ROAD KEY WEST FL 33040 ProNational Insurance Company 2121 Ponce de Leon Boulevard Coral Gables, Florida 33134 March 1, 1999 This is to certify that as of the date of this certificate, the physician named below is/was an insured of ProNational Insurance Company for professional liability insurance for the policy period and limits of coverage shown below: Insured Name MICHAEL D BURTON, DO Policy Period 1/01/99 - 12/31/99 Retroactive Date 11/19/90 Coverage Limits $250,000 / $750,000 The information provided in this Certificate is based on the data in each insured's file and may not reflect changes in process on this date. In the event of cancellation of an insured's policy, the undersigned will endeavor to give written notice to the party to whom this Certificate is issued, but, otherwise, assumes no obligation for giving such notice. This Certificate of Insurance neither affirmatively nor negatively amends, extends or alters the coverage afforded by any policy referred to herein. This Certificate of Insurance contains privileged and confidential information which is intended only for the use of the addressee. ProNational Insurance Company Liddia F. Wilson Authorized Representative _. Kov D R P,rrm i- DATE—_,__.J_ ly INITIAL 3003350 DATE 3�- 3/01/99 rov 4. YFS 305/442-8119 800/222-5115 Fax 305/443-5250 �kProNational INSURANCE COMPANY CERTIFICATE OF INSURANCE MCBOCC ATTN: WAYNE ROBERTSON/RISK MGMT 5100 COLLEGE ROAD KEY WEST FL 33040 2121 Ponce de Leon Boulevard Coral Gables, Florida 33134 June 2, 2 M THIS IS TO CERTIFY that as of the date of this certificate the physician named below is/was an insured of PRONATIONAL INSURANCE COMPANY for professional liability insurance for the policy period limits of coverage shown below: Insured Name MICHAEL D BURTON, DO Policy Period 1/01/00 - 12/31/00 Retroactive Date 11/19/90 Cert . go. 3003350 Coverage Limits $250,000/$750,000 The information provided in this Certificate is based upon the data in each insured's file and may not reflect changes in process on this date. In the event of cancellation of a insured's policy the undersigned will endeavor to give written notice to the party to whom this Certificate is issued, but, otherwise, assumes no obligation for giving such notice. This Certificate of Insurance neither affirmatively nor negatively amends, extends or alters the coverage afforded by any policy referred to herein. This Certificate of Insurance contains privileged and confidential information which is intended only for the use of the addres ee-, - s4'4 - PRONATIONAL INSURANCE COMPANY vc- uthorized Representative 7/98 305/442-8119 800/222-5115 Fax 305/443-5250 www.ProNational.com ProNational INSURANCE COMPANY 2121 Ponce de Leon Boulevard Ponce de Leon Boulevard, Suite 350 PO Box 149001 Coral Gables, Florida 33114 305/442-8119 • 800/222-5115 CERTIFICATE OF INSURANCE TO: MCBOCC ATTN: RISK MGMT 5100 COLLEGE ROAD KEY WEST FL 33040 January 8, 2001 This is to certify that as of the date of this certificate, the physician named below is/was an insured of ProNational Insurance Company for professional liability insurance for the policy period and limits of coverage shown below: Insured Name MICHAEL D BURTON, DO Policy Period 1/01/01 - 12/31/01 Retroactive Date 11/19/90 Coverage Limits $250,000 / $750,000 The information provided in this Certificate is based on the data in each insured's file and may not reflect changes in process on this date. In the event of cancellation of an insured's policy, the undersigned will endeavor to give written notice to the party to whom this Certificate is issued, but, otherwise, assumes no obligation for giving such notice. This Certificate of Insurance neither affirmatively nor negatively amends, extends or alters the coverage afforded by any policy referred to herein. This Certificate of Insurance contains privileged and confidential information which is intended only for the use of the addressee. ProNational Insurance Company /XO-6/� .� Zt/-Ja4,� Liddia F. Wilson Authorized Representative DATE y 3003350 �� L 1/08/01 VATE INITIAL MEDICAL PROFESSIONAL LIABILITY POLICY COVERAGE SUMMARY 1. Policyholder's Name and Address: Michael Denis Burton, D.O. 1446 Kennedy Drive Key West,FL 33040 2. Policy Number: MP35970 3. Policy Period: From 1/1/2002 to 1/1/2003 12:01 a.m. Standard Time at the address of the policyholder as stated above. 4. Total Premium: 5. Schedule of Insureds (Primary Coverage) The following are insureds under the policy, with the following respective limits of liability: Name INSURED PHYSICIANS Michael Denis Burton, D.O. Primary Limits of Liability Retroactive Each Medical Date Incident 11 /19/1990 6. Professional Legal Defense Coverage Premium $250, 000 Annual Deductible Premium Aggregate $750,000 N/A $0.00 included with Policyholder premium above. Limits of Liability NOTE: These limits apply only to legal expenses incurred by covered insureds under the Professional Legal Defense Coverage Part, and not to defense costs incurred which are otherwise covered under the Professional Liability Coverage Part or other parts of the policy. Each Covered Investigation Each Covered Audit Each Policy Period V RISK NAGEMENT WAI"-. 'YES Each Medical Incident $25,000 $5,000 $25,000 By: dw6v Authorize# Repr sentative PNI-MP-020 01 02 Medical Professional Liability Policy Coverage Summary Page 1 ProNational Insurance Company PToNatianalo INSURANCE COMPANY L- A ProAssurance Company Certificate of Insurance TO: Monroe County Government/Risk Management Att Maria Slavik 1100 Simonton Street Key West, FL 33040 THIS IS TO CERTIFY THAT as of this date, the following described insurance is in existence with ProNational Insurance Company. It is the INSURED'S responsibility to advise third parties, including the holder of this certificate, of any changes in this insurance POLICY or the expiration or cancellation of this POLICY. Insured: Michael Denis Burton, D.O. Policy Number: MP35970 Policy Period: 1 /1 /2003 to 1 /1 /2004 Professional Liability Limits: Retroactive Date: 11/19/1990 $250,000 per incident $750,000 aggregate This Certificate of Insurance does not amend, extend or alter the coverage provided by the above -described POLICY. Certified today, March 21, 2003: BY: 0 AP E ,, , MAN I!MENT BY _ CL � DATE.._.. .� _........_� `5 WAIVER N/A YES i V PAI-OF-200 05 02 PmNational® INSURANCE COMPANY �— A ProAssurance Company CERTIFICATE OF INSURANCE To: Monroe County Government/Risk Management Aft Maria Slavik 1100 Simonton Street Key West, FL 33040 This is to certify that as of this date, the following described insurance is in existence with ProNational Insurance Company. It is the insured's responsibility to advise third parties, including the holder of this certificate, of any changes in this insurance policy or the expiration or cancellation of this policy. Insured: Michael Denis Burton, D.O. 1446 Kennedy Drive Key West, FL 33040 Policy Number: MP35970 Policy Period: 01/01/2003 to 01/01/2004 Professional Liability Limits: $250,000 per incident $750,000 aggregate Retroactive Date: 11 /19/1990 This Certificate of Insurance does not amend, extend or alter the coverage provided by the above -described policy. Certified Today, 03/28/2003 In APRR Y ISK M AGEMENT BY DATE WAIVER N/A —YES MAI-OF-200 05 02 02002 PRA PmNational® INSURANCE COMPANY �-- A ProAssurance Company CERTIFICATE OF INSURANCE To: Monroe County Government/Risk Management 1100 Simonton Street Key West, FL 33040 This is to certify that as of this date, the following described insurance is in existence with ProNational Insurance Company. It is the insured's responsibility to advise third parties, including the holder of this certificate, of any changes in this insurance policy or the expiration or cancellation of this policy. Insured: Michael Denis Burton, D.O. 1446 Kennedy Drive Key West, FL 33040 Policy Number: MP35970 Policy Period: 01/01/2004 to 01/01/2005 Professional Liability Limits: $250,000 per incident $750,000 aggregate Retroactive Date: 11/19/1990 This Certificate of Insurance does not amend, extend or alter the coverage provided by the above -described policy. Certified Today, 03/22/2004 MAI-OF-200 05 02 A ISF tBY %7 DATE WAIVER NiA YES,.r,,,,,,r,� 02002 PRA ProNational® INSURANCE COMPANY �— A ProAssurance Company Certificate of Insurance TO: Monroe County Government/Risk Management Credentialing 1100 Simonton Street Key West, FL 33040 THIS IS TO CERTIFY THAT as of this date, the following described insurance is in existence with ProNational Insurance Company. It is the INSURED'S responsibility to advise third parties, including the holder of this certificate, of any changes in this insurance POLICY or the expiration or cancellation of this POLICY. Insured: Michael Denis Burton, D.O. Policy Number: MP35970 Policy Period: 1/1/2005 to 1/1/2006 Professional Liability Limits Retroactive Date: 11/19/1990 $250,000 per incident $750,000 aggregate This Certificate of Insurance does not amend, extend or alter the coverage provided by the above -described POLICY. Certified today, January 5, 2005: BY: A iT rh M,a� C7WA- PAI-OF-200 05 02 CERTIFICATE OF To: Lower Keys Medical Center Attn of: Medical Staff Office 5900 Junior College Road Key West, FL 33040 PToNational® INSURANCE COMPANY �— APtrokW=1Ce Company INSURANCE RECO ED MAY 2 2 MONROE COUNTY This is to certify that as of this date, the following described insurance is in existence with ProNational Insurance Company. It is the insured's responsibility to advise third parties, including the holder of this certificate, of any changes in this insurance policy or the expiration or cancellation of this policy. Insured: Michael Denis Burton, D.O. 1446 Kennedy Drive Key West, FL 33040 Policy Number: MP35970 Policy Period: 01/01/2006to 01I01/2007 Professional Liability Limits: $250,000 per incident $750,000 aggregate Retroactive Date: 11/19/1990 This Certificate of Insurance does not amend, extend or alter the coverage provided by the above -described policy. Certified Today, 12/27/2005 By: MAFUF-200 05 02 '52002 PRA Cc. % "`7 ' r___f�.'EuIVE­ AUG Z 5iry'AofeIiom MONROE MATTY I RISK MANAGEMENT Insurance Company MEMORANDUM OF INSURANCE TO: NAMED INSURED: MONROE COUNTY BOARD OF CO. COMMISSION ERSMICHAEL DENIS BURTON, D.O. 1100 SIMONTON ST 1446 KENNEDY DRIVE KEY WEST, FL 33040 KEY WEST, FL 33040 This is to advise you that the First Professionals Insurance Company, Inc. has issued to the named insured the policy enumerated below, subject to all the terms of such policy. This memorandum neither affirmatively or negatively amends, extends or alters the coverage of such policy. POLICY TYPE OF CLAIMS REPORTING NUMBER INSURANCE LIMITS PERIOD 80148 Professional 250,000 each claim From: 01/01/2008 Liability 750,000aggregate To: 01/01/2009 Retroactive Date: 11A9/1990 Class 40 - GENERAL PRACTICE -NO SURGERY Date Issued: 08/14/2008 FPIC-9(1/86) C C. Vice President of Underwriting 450/2 FL-005037 1000 Riverside Avenue, Suite 800 • Jacksonville, Florida 32204 • (904) 354-5910 • 1-800-741-3742 • Fax (904) 358.6728 P.O. Box 44033 • Jacksonville, Florida 32231-4033 • www.firstprofessionals.com UW005-1 First Professionals Insurance Co., Inc. Page: 1 08/14/2008 P.O. Box 44033 Jacksonville, FL 32231 (800)741-3742 (904)354-5910 Fax (904)358-6728 Claim History This document reflects the requested All Time FPIC claim history for the insured. License Number: 05037 Insured: Michael Burton, D.O. Key West Family Medicine Center 1446 Kennedy Blvd Key West, FL 33040 Retro Date: 11/19/1990 Polic Claim# Report Date Loss Date Settle Date Suit Status Indemnity Paid Total: *** NO CLAIMS *** FPIC provides coverage for a claim when notified of an adverse event by the submission of an 'Incident Report' during the policy period for damages. Laura L. Archer, CPCU Vice President, Underwriting Details of the claim should be obtained from the physician. CC: Michael Burton, D.U. Key West Family Medicine Center 1446 Kennedy Blvd Key West, FL 33040 A c RDA CERTIFICATE OF DATE (MM/DD/YYYY) LIABILITY INSURANCE 02/03/2010 PRODUCER Marsh USA Inc. 701 Market Street Suite 1100 t THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION 1 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. St. Louis, MO 63101 Attn: att.certrequest@marsh.com 018766-GAW-CRT-09/10 BCS 3 N INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Old Republic Insurance Co i 24147 - AT&T Inc. and Subsidairies BellSouth Communication Systems, LLC One AT&T Plaza 208 South Akard INSURER B: N/A N/A INSURER C: N/A N/A INSURER D: Dallas, TX 75202 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. NS LTR ADD' INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DDNYYY) POLICY EXPIRATION DATE (MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE1,000,000 A X COMMERCIAL GENERAL LIABILITY MWZY58335 06/01 /2009 06/01 /2010 DAMAGE TO RENTED PREMISES Ea occurrence 1,000,000 MED EXP (Any one person) $ 10,000 CLAIMS MADE FXI OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 10,000,000 GENERAL AGGREGATE LIMIT APPLIES PER POLICYF—] ECOT- LOC PRODUCTS - COMP/OP AG $ 1,000,000 A AUTOMOBILE LIABILITY X ANY AUTO MWTB20699 06/01 /2009 06/01 /2010 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY $ ALL OWNED AUTOS SCHEDULED AUTOS (Per person) BODILY INJURY $ HIRED AUTOS NON -OWNED AUTOS L6 (Per accident) PROPERTY DAMAGE (Per accident) $ of GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGG $ $ EXCESS / UMBRELLA LIABILITY OCCUR CLAIMS MADE r EACH OCCURRENCE $ AGGREGATE $ $ DEDUCTIBLE 1 RETENTION $ A WORKER6 COMPENSATION AND MWC11610400 06/01 /2009 06/01 /2010 X I WC STATU- OTH- TORY LIMITS ER EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N E.L. EACH ACCIDENT 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 OFFICER/MEMBER EXCLUDED? .L. DISEASE - POLICY LIMIT $ 1,000,000 ndory in NH) If yes, describe under MECIALPROVISIONS below 01 AA OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Monroe County Board of County Commissioners is included as an Additional Insured under the General Liability policy but only with respect to the requirements of the contract between the Certificate Holder and BellSouth Communication Systems, LLC. CERTIFICATE HOLDER CHI-002784850-01 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Monroe County Board of EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL County Commissioners 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Attn: Lisa Druckemiller BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND 1200 Truman Avenue, Suite 211 Key West, FL 33040 jIUPPO�NEQ j THE INSURER, ITS AGENTS OR REPRESENTATIVES. AU Of Marsh USI PRESENTATIVE Mary Radaszewski ACORD 25 (2009/01) ©1998-2009 ACORD CORPORATION. All Rights Reserved The ACORD name and logo are registered marks of ACORD IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. Aco FA ft-O"N"IN W. a a 0 . ir pd,'!;A FI-ST I'tc �e;sioZals lZSUTance Com JA N 2010 COY Hoide� Cop FIR.-S'V .PROFESSIONALS, INSIJkk CE COMPANY, INC- MEMORANDUM OF INSURANCE POLICY INFOR.MATION ?famed Lis sreeL Nbichae l Bunon,- D.O. Pc�iicy :.zrnbe.-: IN480148 .. PoIicy Period: 01i01I2010 to 0110lt2011 Ren; o acriv e Date.- 11 2 911990 Ll:-nits Of Liability. '0,000 per claim S'i 50,004 aWegate Gene al Pnctice - No Surgery klemora.cdum of Insurar ce Isst e Daze: 101 %012009 F first Professionals Ir_sl:rance Company, Inc. hereby issues this Memorandum of Imm-ance io verifv that we hay. issued a medical professional liability insurance policy to the above named insured with coverage and limits of liability as set forth This Memorandum of Insurance shall not be construed in any way whatsoever.as am- nciag any of e terms, dzf w;*ians, conditions or exclusions of the policy issued to the above Ll'2.JT1 J PIC CONTACT INFO.RWkTIO`. The following information may be used to contact our company: First Professionals L s.urance Cc::F.any, Inc., P.O. Box 44033, Jacksonville, Florida 32231-4033; or Phone t9�043 3 -59 i U. �;80Q j = --1 / 42; or Facsirnile (904) 358--67?$. Authorized Representative LPL t�;8 _, �204 �' ll��.... � 3i -� 1.�� • -' 3'-)C-- 1 1 �7 1 ? Fax � �� �+ t y �✓`1 J" ' a ~ �.\ 1 1 - tt .l.�) I ♦ i v . �... r .li J `f' L .? �.1: ✓i' �.� [ S 6,/ r{� . t.~.5 l �l . J - c F-TZ1 F A@cam i�Gim First Professionals Insurance Company FIRST PROFESSIONALS INSURANCE COMPANY, INC. MEMORANDUM OF INSURANCE Michael Burton, D.O. Key West Family Medicine Center 1446 Kennedy Blvd Key Wcst, FL 33040 POLICY INFORMATIO Named Insured- Michael Burton, D.O. Policy Number: IN080148 Policy Period: 01/01/2011 to 01/01/2012 Retroactive Date: 11/19/1990 Limits of Liability: $250,000 per claim/$750,000 aggregate Classification: General Practice - No Surgery Memorandum of Insurance Issue Date: 05/11/2011 First Professionals Insurance Company, Inc. hereby issues this Memorandum of Insurance to verify that we have issued a medical professional liability insurance policy to the above named insured with coverage and limits of liability as set forth above. This Memorandum of Insurance shall not be construed in any way whatsoever as amending any of the terms, definitions, conditions or exclusions of the policy issued to the above named insured. FPIC CONTACT INFORMATION. The following information may be used to contact our company: First Professionals Insurance Company, Inc., P.Q. Box 44033, Jacksonville, Florida 32231-4033; or Phone (904) 354-5910, (800) 741-3742; or Facsimile (904) 358-6728, 'L /404t Authorized Representative FPIC-MPL-103-FL (12109) 1000 Riverside Avenue, Suite 800 • Jacksonville, Florida 32204 • (904) 354.5910 • 1.800.741-3742 • Fax (904) 358.6728 PO. Box 44033 0 Jacksonville, Florida 32231.4033 0 ww+v.firstprofessionals.com 411 VA& • is First Professionals Insurance Company FIRST PROFESSIONALS INSURANCE COMPANY, INC. MEMORANDUM OF INSURANCE Michael Burton, D.O. Key West Family Medicine Center 1446 Kennedy Blvd Key West, FL 33040 POLICY INFORMATIO Named Insured: Michael Burton, D.O. Policy Number: IN080148 Policy Period: 01/01/2011 to 01/01/2012 Retroactive Date: 11/19/1990 Limits of Liability: $250,000 per claim/$750,000 aggregate Classification: General Practice - No Surgery Memorandum of Insurance Issue Date: 05/11/2011 First Professionals Insurance Company, Inc. hereby issues this Memorandum of Insurance to verify that we have issued a medical professional liability insurance policy to the above named insured with coverage and limits of liability as set forth above. This Memorandum of Insurance shall not be construed in any way whatsoever as amending any of the terms, definitions, conditions or exclusions of the policy issued to the above named insured. FPIC CONTACT IN FOR&1ATION. The following information may be used to contact our company: First Professionals Insurance Company, Inc., P.O. Box 44033, Jacksonville, Florida 32231-4033; or Phone (904) 354-5910, (800) 741-3742; or Facsimile (904) 358-6728. Authorized Representative EPIC-MPL• 103.FL (12/08) I 1000 Riverside Avenue, Suite 800 • Jacksonville, Florida 32204 • (904) 354-5910 • P.O. Box 44033 • Jacksonville, Florida 32231.4033 • wwu 1-800.741-3742 •Fax (904) 358-6728 firstprofessiona[s.cam .�® r. A:e. 1 %-®R1 first 1'n>f a,iuna;, In,unuuc (01-a mm FIRST PROFESSIONALS INSURANCE COMPANY, INC. MEMORANDUM OF INSURANCE POLICY INFORM- ATION �,,amed Insured: Policy Number: IN080148 Policy Period :Zecoactive Date: 1 9/1-990 t-irms of Liability: $250,000 per claim/$750,000 aggregate Classification: General Practice - No Surgery 'Atmorandum of Insurance Issue Date: 10/07/201 1 COT Holder Cope E irs. Professionals Insurance Company, Inc. hereby issues this Memorandum of Insurance to verify that we. `:sve issued a medical professional liability insurance policy to the above named insured with coverage and Tunas of liability as set forth above. This Memorandum of Insurance shall not be construed in any way �k hatsoever as amending any of the terms, definitions, conditions or exclusions of the policy issued to the above rna;ned insured. iFPIC CONTACT INFORMATION.The following information may be used to contact our company: i u,a Professionals Insurance Company, Inc., P.O. Box 44033, Jacksonville, Florida 32231-4033; or Phone (904)354-5910, (800) 741-3742; or Facsimile (904) 358-6728. 4 14ue�' Authorized Representative BY OV Y RI81(MANAGEI1�Ni W -- Y Ca"ZL ."1UC. �'u iC `�. • �•�C'�4'abl: %i:, 1-i; ,lld;. i22104 • (904) 354-5910 • 1- 0(1-71,41-)74• i.x1y hid. R;:••< 44J • j:�c:;<u!:o .. , 1>nriu:t >< 31♦U>�3;��va�.ius��lu:cs<.il�n,.ls.:.nn 1000 THEDOCTORSGOMPANY Effective Date: 01101/2013 First Named Insured. Michael Burton DO Key West Family Medicine Center 1446 Kennedy Blvd Key West, FL 33040 Protected Party: Michael Burton Do — Issue Date: 12127/2012 A Claims -Made Professional Llability Policy demonstrates coverage in force on the Effective Date listed. It is issued 86 a matter of information and does not confer rights to any recipient. This document is not binding, is not part of the Policy described below, and does not change or extend the coverage provided by that Policy. Specialty: FGP01 Family General Practice No Surgery Policy Nu 0911562 The Protected Party above is. © A Named insured A Locum Tenens ❑ An Additional Protected Party Policy Period From: 01/01f2013 To: 01/01/2014 Agency and Address: FPIC Insurance Agency, Inc., Jacksonville, Florida Eastern Mail Sarvice Center PO Box 4220 East Lansing, MI 48M (800) 741-3742 LIMTS OF LIABILITY Claim Limit: $250,000 Aggregate Limit $750,000 11/19/19W I. Locum Tenens and Additional Protected Parties share Limits of Liability with the applicable Named Insured. 11. Individuals who occupy a "slot' share Limits of Liability witn all others who occupy the same "slot"' during the Policy Period, 111. Photocopies of this document are deemed as valid as the original IV. The policy, including endorsements, determines the coverage provided. Some claims may not be covered by the terms of the policy, or may be subject to restrictions such as lower Limits of Liability. V. If the policy, or coverage for any person, is canceled for any reason or if the terms of the policy are changed, we will notify the First Named Insured only. Coverage Is not in effect unless and until all payments are received when due. MPLOo3 (08ro6) 03 Pegs 1 of 1 N►C003 8042193 - 00 InSUrad 185 Greenwod Road: P o, Box 2900. Nape. CA 94558-0900 ; (707)226-0100 : (800)421.2388 : www thadoctors.com ` e P RISK BGEAI�VT J� DA - ' �.r W c.C, � WACVVl nHEDOCTORSCOMPANY CERTIFICATE OF INSURANCE Effective Date: 01/01/2014 First Named Insured. - Michael Burton DO Key West Family Medicine Center 1446 Kennedy Blvd Key West, FL 33040 Protected Party: Michael Burton DO Issue Date: 11/04/2013 A Claims -Made Professional Liability Policy IMPORTANT NOTICE: This document demonstrates coverage in force on the Effective Date listed. It is issued as a matter of information and does not confer rights to any recipient. This document is not binding, is not part of the Policy described below, and does not change or extend the coverage provided by that Policy. Specialty: FGP01 Family General Practice No Surgery Number: 0911552 Retroactive Date: 1 11 /19/1990 The Protected Party above is: EX] A Named Insured ❑ A Locum Tenens ❑ An Additional Protected Party Claim Limit: Aggregate Limit: olicy Period: From: 01/01/2014 Departure Period: From: NIA To: 01 /01 /2015 To: NIA Agency and Address: The Doctors Company Insurance Services, LLC, Jacksonville Eastern Mail Service Center PO Box 4220 East Lansing, MI 48826 (800) 741-3742 LIMITS OF LIABILITY $250,000 $750,000 I. Locum Tenens and Additional Protected Parties share Limits of Liability with the applicable Named Insured. III. Individuals who occupy a "slot' share Limits of Liability with all others who occupy the same "slot' during the Policy Period. 111. Photocopies of this document are deemed as valid as the original. IV. The policy, including endorsements, determines the coverage provided. Some claims may not be covered by the terms of the policy, or may be subject to restrictions such as lower Limits of Liability. V. If the policy, or coverage for any person, is canceled for any reason or if the terms of the policy are changed, we will notify the First Named Insured only. Coverage is not in effect unless and until all payments are received when due. VI. If a departure period is indicated, the policy will not respond to Probable Claim Events arising from Professional Services Incidents or Review Incidents that take place during the designated period-, however, the policy will respond if we receive a claim report during this period. AP �EM Y r . CjWi Si inn "byaZ MPL003 (06106) 638 Page! of 1 MC003 8974615 - 00 Insured 185 Greenwood Road: P.O. Box 2900 : Napa, CA 94558-0900 (707)226-0100 : (800)421-2368 : www.thedoctors.com �THEDOCTORSCOMPANY CERTIFICATE OF INSURANCE Effective Date: 01/01/2015 First Named Insured: Michael Burton DO Key West Family Medicine Center 1446 Kennedy Blvd Key West, FL 33040 Protected Party: Michael Burton DO Issue Date: 11/03/2014 A Claims -Made Professional Liability Policy IMPORTANT NOTICE: This document demonstrates coverage in force on the Effective Date listed. It is issued as a matter of information and does not confer rights to any recipient. This document is not binding, is not part of the Policy described below, and does not change or extend the coverage provided by that Policy. Specialty: FGP01 Family General Practice No Surgery _PoILcy Number: 0911552 Retroactive Date: 11 /19/1990 The Protected Party above is: [] A Named Insured L] A Locum Tenens L] An Additional Protected Party Claim Limit: Aggregate Limit: Policy Period: _ From: 01/01/2015 To: 01/01/2016 Departure Period: From: N/A To: N/A Agency and Address: The Doctors Company Insurance Services, LLC, Jacksonville Eastern Mail Service Center PO Box 4220 East Lansing, MI 48826 (800) 741-3742 LIMITS OF LIABILITY I. Locum Tenens and Additional Protected Parties V. share Limits of Liability with the applicable Named Insured. II. Individuals who occupy a "slot" share Limits of Liability with all others who occupy the same -slot-- during the Policy Period. III. Photocopies of this document are deemed as valid as the original. IV. The policy, including endorsements, determines the coverage provided. Some claims may not be covered by the terms of the policy, or may be subject to restrictions such as lower Limits of Liability. 0 $250,000 $750,000 If the policy, or coverage for any person, is canceled for any reason or if the terms of the policy are changed, we will notify the First Named Insured only. Coverage is not in effect unless and until all payments are received when due. VI. If a departure period is indicated, the policy will not respond to Probable Claim Events arising from Professional Services Incidents or Review Incidents that take place during the designated period; however, the policy will respond if we receive a claim report during this period. q �� MPL003 (06/06) 63890 Pago 1 of 1 MC003 9684570 - 00 Insured 185 Greenwood Road: P.O. Box 2900 : Napa, CA 94,»8 0900, (707)226-0100 : (800)421-2368 : www-thedoctors-com The Doctors Company /\T N EDOCTORS G€}M PANY CERTIFICATE OF INSURANCE Issue Date: 0111312016 Effective Date: 01/01/2016 A Claims -Made Professional Liability Policy First Named Cnsured: IMPORTANT NOTICE: This document Michael Burton DO demonstrates coverage in force on the Effective Key West Family Medicine Center Date listed. It is issued as a matter of information 1446 Kennedy Blvd and does not confer rights to any recipient. This Key West, FL 33040 document is not binding, is not part of the Policy described below, and does,not change or extend the coverage provided by that Policy. Protected Party: Michael Burton DO Specialty: FGP01 Family General Practice No Surgery ----- -- - - - - __ -- -- -- -- --- -_ _.. _ _--- --- -Policy Period- - - - Policy Number. 0911552 From:( 01101 /2016 Retroactive Date: Departure Period: 11 /19/1990 The Protected Party above is: FXX] A Named Insured El A Locum Tenens An Additional Protected Party Claim Limit: Aggregate Limit: From: N/A 01/01/2017 To: N/A Agency and Address: The Doctors Insurance Agency 12724 Gran Bay Parkway, W. Suite 400 Jacksonville, FL 32268 (877) 320-0748 LIMITS OF LIABILITY $260,000 $760,000 I. Locum Tenens and Additional Protected Parties share Limits of Liability with the applicable Named Insured. II. Individuals who occupy a "slot' share Limits of Liability with all others who occupy the same "slot" during the Policy Period. III. Photocopies of this document are deemed as valid as the original. IV. The policy, including endorsements, determines the coverage provided. Some claims may not be covered by the terms of the policy, or may be subject to restrictions such as lower Limits of Liability. 3 r­> . 0 . �r = rn� N -v -� C- - - W V. If the policy, or coverage for any person, is cr. canceled for any reason or if the terms of the policy are changed, we will notify the First Named Insured only. Coverage is not in effect unless and until all payments are received when due. VI. If a departure period is indicated, the policy will not respond to Probable Claim Events arising from Professional Services Incidents or Review Incidents that take place during the designated period, however, the policy will respond if we receive a claim report during this period. AY PR E GE�MENTO WAIVER N/A YES` C.l �1 le, GVl risn rv,- r(7 0 Insured Pa el of 1 MC003 12512004 - 0 MPL003 (06/06) 99614 9 185 Greenwood Road: P.O. Box 2900 : Napa, CA 94558-0900 : (707)226-0100 : (800)421-2368 : www.thedoctors.com • THEDOCTORSCOMPANY CERTIFICATE OF INSURANCE Issue Date: 11/02/2017 • Effective Date: 01/01/2018 A Claims -Made Professional Liability Policy First Named Insured: IMPORTANT NOTICE: This document is issued as Michael Burton DO a matter of information and does not confer rights Key West Family Medicine Center to any recipient. This document is not binding, is 1446 Kennedy Blvd not part of the Policy described below, and does Key West, FL 33040 not change or extend the coverage provided by that Policy. Insured: Michael Burton DO Specialty: FGP01 - Family General Practice No Surgery Policy Number: Policy Period: 0911552 From: 01/01/2018 To: 01/01/2019 Retroactive Date: Departure Period: 11/19/1990 From: N/A To: N/A The Insured above is: Agency and Address: D A Named Insured The Doctors Company insurance ❑ A Locum Tenens Services ❑ An Additional Insured 12724 Gran Bay Parkway, W . • Pag Suite 400 Jacksonville, FL 32258 (877) 320 -0748 LIMITS OF LIABILITY Claim Limit: $250,000 Aggregate Limit: $750,000 IV. The Policy, including Endorsements, determines the coverage provided. Some Claims may not be covered by the terms of the Policy, or may be subject to restrictions such as lower Limits of APRN i _ D'? .RS ENT Liability. By. *� V. If the Policy, or coverage for any person, is 111M• canceled for any reason or if the terms of the Policy are changed, we will notify the First Named Insured (and any additional Named Insureds as required by applicable state law). Coverage is not in effect unless and until all payments are received 1. Locum Tenens and Additional Insureds share when due. Limits of Liability with the applicable Named VI. If a Departure Period is indicated, the Policy will Insured. not respond to Probable Claim Events arising from II. Individuals who occupy a "slot" share Limits of Professional Services Incidents or Review Liability with all others who occupy the same "slot" Incidents that take place during the designated during the Policy Period. period: however, the Policy will respond if we $ 111. Photocopies of this document are deemed as valid receive a Claim Report during this period. as the original. • MPL003 (04/15) 99614 Page 1 of 1 MCO2003 19668958 - 00 Insured 185 Greenwood Road : P.O. Box 2900 : Napa, CA 94558 -0900: (707)226 -0100: (800)421.2368: www.thedoctors.com c, c ftlieutadt •