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Home My WebLink About2nd Renewal 09/10/2025 GVS COURTq° o: A Kevin Madok, CPA - �o ........ � Clerk of the Circuit Court& Comptroller Monroe County, Florida �z cooN DATE: September 26, 2025 TO: Mark Gongre, Senior Safety and Security Administrator Employee Services Kelly Cummings, Executive Administrator Employee Services FROM: Liz Yongue, Deputy Clerk SUBJECT: September 10, 2025 BOCC Meeting The following item has been executed and added to the record: C20 Contract renewal with Relation Insurance Services of Florida, Inc., for Workers' Compensation third-parry claims administration (TPA), per renewal clause in current contract. All other terms and provisions of the Contract not modified by this renewal, or any other amendments or addenda, shall remain unchanged. Should you have any questions, feel free to contact me at(305) 292-3550. cc: County Attorney Finance File KEY WEST MARATHON PLANTATION KEY 500 Whitehead Street 3117 Overseas Highway 88770 Overseas Highway Key West, Florida 33040 Marathon, Florida 33050 Plantation Key, Florida 33070 SECOND RENEWAL TO MONROE COUNTY CONTRACT FOR WORKER'S COMPENSATION THIRD PARTY CLAIMS ADMINISTRATION SERVICES This Second Renewal(this"Renewal"), is entered into by and between Relation Insurance Services of:Florida, Inc..("Relation"), and Monroe County Board of.County Commissioners ("County"). BACKGROUND Relation and:the County are parties to a Contract for Worker's Compensation Third Party, Claims Administration Services (the"Contract") dated September 21, 2021, under which Relation provides Worker's Compensation Administration Services to the County; . and The parties desire to renew the contract in accordance with Section 3.1 of the Contract; and Pursuant to the terms of Section 3.1 the Contract is renewable at.the County's option for two (2) additional consecutive one year terms.The date of the expiration of the initial term (September 21, 2024). The Effective Date of the First Renewal was September 22, 2024. The Effective date of this Renewal shall be September 22, 2025. All other terms and provisions of the Contract not modified by this renewal, or any other amendments or addenda, shall remain unchanged: IN WITNESS WHEREOF, Relation and the County have executed this Renewal as of the effective date above. For Relation: Monroe County Board of Commissioners o D cu$igne d by:. ak. 40. , . . p ..0 0 ,,,--,-i-v .... , dn. - B By: fir y• t3a�i�50504F40A.,. • Z ........ Timothy J. Hall r, .yor/Chairman , rri . A.45,,,-,0 )ri_______I ,,,,t, ,,,,,3,"c..., A „:„„ Title.CEO ei ‘;',c-.13 23 i L'a. Pt— -13 .7/31/2025 ..,-,4, . C '., i,. c Date. ` e �' i.i.,:,-„w... r ►' %`,\,,,\_t_-,-7,.-_'-_--_-...,—_- 0_:,..,:'i*,,c,,,l,,, r-= - Kevin Madok Clerk ri‘. cd.T.1,' t „3=c,7 Approved as to form and legal sufficiency: ti�yo o County o 's'�Of�ic k,.,`cz�al..Z.��,�:.,1 ,, Monroe n At me -.;�, p,y .;rty: V + le-C.4- 4it- . a FY C/otaif.49:diee- i . . As slant CountyAttorrie D e p U tyClerk y Date September 24,2025 :.. DATE(MMIDD/YYYY) AC"R" CERTIFICATE OF LIABILITY INSURANCE 06/23/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Miriam Fox NAME: Relation Insurance Services,Inc. a/cNr o Ext: (925)407-0417 a/c,No): (925)322-6655 2300 Contra Costa Blvd E-MAIL miriam.fox@relationinsurance.com ADDRESS: Suite 525 INSURER(S)AFFORDING COVERAGE NAIC# Pleasant Hill CA 94523 INSURERA: Great Northern Insurance Company 20303 INSURED INSURER B: Chubb National Insurance Company 10052 AQ Sunshine Parent,LLC and its subsidiaries INSURER C: Allied World Surplus Lines Ins 24319 Relation Insurance Inc.,Relation Insurance Services,Inc. INSURER D: 2300 Contra Costa Blvd.Suite 525 INSURER E Pleasant Hill CA 94523 INSURER F: COVERAGES CERTIFICATE NUMBER: 25/26 GL BA WC 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 TYPE OF INSURANCEAUULbUBK POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MMIDD/YYYY MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FX OCCUR PREM SDAMAGES Ea oNcurDreme $ 1,000,000 MED EXP(Any one person) $ 10,000 A Y 3609-28-26 06/18/2025 06/18/2026 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 JECT LOC PRODUCTS-COMP/OPAGG $POLICY El PRO 2,000,000P1 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANYAUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED 7365-26-90 06/18/2025 06/18/2026 BODILY INJURY(Pe r accide nt) $ AUTOS ONLY AUTOS X HIRED �/ NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY X AUTOS ONLY Per accident n� vn $ BY- UMBRELLA LIAB OCCUR 9_Zd,.2 _—...._.m. EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE WA MM NAa ' AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION X1 SPER TATUTE EORH AND EMPLOYERS'LIABI LI TY Y/N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ B OFFICER/MEMBER EXCLUDED? ❑ N/A 7184-45-41 06/18/2025 06/18/2026 (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 $ Errors and Omissions Per Claim $5,000,000 C 0313-9753 06/30/2025 06/30/2026 Aggregate $5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Insured:Relation Insurance Services of Florida,Inc. Monroe County,Florida,has been included as additional insured with respect to General Liability&Auto Liability when required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Monroe County,Florida ACCORDANCE WITH THE POLICY PROVISIONS. 1100 Simonton Street AUTHORIZED REPRESENTATIVE Key West FL 33040 I @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD