FY1994 10/20/1993 Agreement
.ll1ft!' 'I.. a.1IJ11t
BRANCH OFFICE
3117 OVERSEAS HIGHWAY
MARATHON,nOmDA3~~
TEL. (305) 289-6027
CLERK OF THE CIRCUIT COURT
MONROE COUN1Y
500 WHITEHEAD STREET
KEY WEST, FLORIDA 33040
TEL. (~5) 292-35~
BRANCH OFFICE
88820 OVERSEAS HIGHWAY
PLANTATION KEY, nOmDA 33070
TEL. (305) 852-7145
M ~ M Q B A If 12 1(M
TO:
Division of Management Services
c/o County Administrator
FROM:
Attn: Melonie Bryan, Director
'Office of Management & Budget
Isabel C. DeSantis, Deputy Clerk
~.c.. tJ.
DATE:
December 17, 1993
On October 20, 1993, the Board authorized execution of a Contract
Agreement between Monroe County and Aids Help, Inc., to provide
assistance to Monroe County, in the amount of $34,000.00.
The Board also authorized execution of a Contract Agreement
between Monroe County and the Florida Keys Youth Club, to provide
assistance to Monroe County, in the amount of$30,000.00.
Enclosed are duplicate originals of the subject Agreements
executed and sealed by all parties which should be returned to
the providers.
cc: County Attorney
Finance
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AGREEMENT
AGREEMENT, made as of this a.a..th. day of Oc.-.tc' be-r , 1993,
between the BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY,
FLORIDA, (the "County") and AIDS HELP, INC., ("Aids Help").
WHEREAS, the Board and Aids Help desire to enter into an
agreement wherein the Board contracts for services from Aids Help
in providing the medical, psychological, physical and social
needs of AIDS or AIDS-related persons and their families and to
mobilize other community resources to meet such needs for the
citizens of Monroe County, Florida, and
WHEREAS, such services have been provided by Aids Help in
the past and have been invaluable to the citizens of Monroe
County, and
WHEREAS, the Board recognizes the public purpose to be met
by an agreement for services to be rendered in fiscal year
1993-94; now, therefore,
IN CONSIDERATION of the promises made each to the other, the
Board and Aids Help agree as follows:
1. AMOUNT OF AGREEMENT. The Board, in consideration of
Aids Help satisfactorily performing the duties of the Board as to
rendering services to the citizens of Monroe County, Florida, in
matters of health and education in regard to the care of
AIDS or AIDS-related persons, shall pay to Aids Help the sum of
Thirty Four Thousand Dollars ($34,000) for fiscal year 1993-94.
2. TERM. This Agreement shall commence October 1, 1993,
-
and terminate September 30, 1994, unless earlier terminated
pursuant to other provisions herein.
3. PAYMENT. Payment will be paid monthly as hereinafter
set forth. On or before the 15th of each month, Aids Help shall
submit to the Board its request for reimbursement. Evidence of
payment shall be in the form of cancelled checks submitted by
Aids Help to the Board. After the Clerk of the Board examines
and approves the monthly request for reimbursement, the Board
shall reimburse Aids Help. However, the total of said monthly
payments in the aggregate sum shall not exceed the total amount
of Thirty Four Thousand Dollars ($34,000) during the term of this
contract.
4. SCOPE OF SERVICES. Aids Help, 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 AIDS or AIDS-related persons and their families and shall
mobilize other community resources to meet such needs for the
citizens of Monroe County, Florida.
5. RECORDS. Aids Help shall maintain appropriate records
to insure a proper accounting of all funds and expenditures, and
shall provide a clear financial audit trail to allow for full
accountability of funds received from the 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.
2
Aids Help 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, Aids Help shall be billed by the Board
for the amount of the audit exception and Aids Help shall
promptly repay any audit exception.
6. INDEMNIFICATION AND HOLD HARMLESS. Aids Help 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 property 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 rendered under
this agreement by Aids Help or any of its agents, employees,
officers, subcontractors, in any tier, occasioned by the
negligence or other wrongful act or omission of Aids Help or its
subcontractors in any tier, their employees or agents. In the
event the completion of services is delayed or suspended as a
result of Aids Help's failure to purchase or maintain required
insurance, Aids Help shall indemnify the Board from any and all
increased expenses resulting from such delay. The first Ten
Dollars ($10.00) of remuneration paid to Aids Help is for the
3
indemnification provided above. The extent of liability is in no
way limited to, reduced, or lessened by the insurance require-
ments contained elsewhere within this agreement.
7. INDEPENDENT CONTRACTOR. At all times and for all
purposes hereunder, Aids Help is an independent contractor and
not an employee of the Board. No statement contained in this
agreement shall be construed so as to find Aids Help 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, Aids Help shall abide by all
statutes, ordinances, rules and regulations pertaining to or
regulating the provisions of, such services, including those now
in effect and hereinafter adopted. Any violation of said
statutes, ordinances, rules or 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 Aids Help.
9. PROFESSIONAL RESPONSIBILITY AND LICENSING. Aids Help
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 Aids Help's program and staff.
4
10. INSURANCE. Aids Help shall obtain, prior to the
commencement of work governed by this agreement, at Aids Help's own
expense, that insurance specified in the insurance forms attached
hereto and incorporated herein by reference. Aids Help will also
insure that all subcontractors, in any tier, have obtained the
insurance as specified in the attached schedules. Aids Help will
not be reimbursed for any work commenced prior to coverage with
required insurance. Aids Help will not be reimbursed for any
services governed by this contract until satisfactory evidence of
the required insurance has been furnished to the Board via either
Monroe County's certificate of insurance or a certified copy of
the actual insurance policy. Delays in the commencement of work,
resulting from the failure of Aids Help to provide satisfactory
evidence of the required insurance, shall not extend deadlines
specified in this agreement. Aids Help shall maintain the
required insurance throughout the entire term of this agreement.
Failure to comply with this provision may result in the immediate
termination of reimbursement.
The Board, at its sole option, has the right to request a
certified copy of any or all insurance policies required by this
agreement. If a certificate of insurance is provided, the
County-prepared form must be used. "Accord Forms" are not
acceptable.
All insurance policies must specify that they are not
subject to cancellation, non-renewal, material change, or
reduction in coverage unless a minimum of thirty (30) days prior
notification is given to the Board by the insurer. The standard
5
language of "endeavor to provide notification" is insufficient.
The acceptance and/or approval of Aids Help's insurance shall not
be construed as relieving Aids Help from any liability or
obligation assumed under this agreement or imposed by law.
Monroe County, Monroe County Board of County Commissioners,
its employees and officials shall be included as "additional
insureds" on all policies, except for worker's compensation.
Any deviations from these general insurance requirements
must be requested in writing on the County-prepared form entitled
"Request for Waiver or Modification of Insurance Requirements"
and approved by Monroe County's Risk Manager.
11. MODIFICATIONS AND AMENDMENTS. Any and all modifica-
tions of the services and/or reimbursement of services shall be
amended by an agreement amendment, which must be approved in
writing by the Board.
12. NO ASSIGNMENT. Aids Help 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 Aids Help.
6
13. NON-DISCRIMINATION. Aids Help shall not discriminate
against any person on the basis of 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, promoting, terminating or any other area
affecting employment under this agreement. At all times, Aids
Help shall comply with all applicable laws and regulations with
regard to employing the most qualified person(s) for positions
under this agreement. Aids Help 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 other characteristic or aspect in its providing of
services.
14. AUTHORIZED SIGNATORY.
The signatory for Aids Help,
below, certifies and warrants that:
(a) Aids Help's name in this agreement is the full name as
designated in its corporate charter, if a corporation, or the
full name under which Aids Help is authorized to do business in
the State of Florida;
(b) He or she is empowered to act and contract for Aids
Help; and
(c) This agreement has been approved by the Board of
Directors of Aids Help, if Aids Help is a corporation.
15. 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:
7
For Board:
Monroe County Attorney
310 Fleming St., Rm. 29
Key West, Florida 33040
Aids Help, Inc.
P.O. Box 4374
Key West, Florida 33040
16. 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.
17. NON-WAIVER. Any waiver of any breach of covenants
herein contained to be kept and performed by Aids Help 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.
For Aids Help:
18. 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 Aids Help.
The Board shall not be obligated to pay for any services or goods
provided by Aids Help after Aids Help has received written notice
of termination, unless otherwise required by law.
19. 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.
20. 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 agreements
with respect to such subject matter between Aids Help and the
Board.
8
IN WITNESS WHEREOF, the parties hereto have caused these
presents to be executed as of the day and year first written
above.
(SEAL)
ATTEST: DANNY L. KOLHAGE, CLERK
BY..aal.d c. A~
'beputy Yl'er
By
COUNTY COMMISSIONERS
COUNTY, FLORIDA
~--
~
al.rman
(SEAL)
ATTEST:
AIDS HELP, INC.
By
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By tt~ /t!;fA/L-
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l\p,iI2l. 199.1
ISll',illlillg
WORKERS' COMP(~NSA TION
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
AIDS HELP, INC.
Prior to the commencement of work governed by this contract, the Contractor shall ohtain
Workers' Compensation Insurance with limits sullicient to respond to Florida Statute 4tJO.
In addition, the Contractor shall obtain Employers' Liability Insurance with limits of not less than:
$100,000 Bodily Injury by Accident
$500,000 Bodily I~jury by Disease, policy limits
$100,000 Bodily Injury by Disease, each employee
Coverage shall be maintained throughout the entire term of the contract.
Coverage shall be provided by a company or companies authorized to transact business in the
state of Florida and the company or companies must maintain a minimum rating of A-VI, as
assigned by the AM. Best Company.
J f the Contractor has been approved by the Florida's Department of Labor, as an au thorized self-
insurer, the County shall recognize and honor the Contractor's status. The Contractor may be
required to submit a Lelter of Authorization issued by the Department of Labor and a Certificate
ofInsurance, providing details on the Contractor's Excess Insurance Program.
If the Contractor participates in a self-insurance fund, a Certificate of Insurance will be required.
In addition, the Contractor may be required to submit updated financial statements from the fund
upon request from the County.
^dministrali\'c In\1rul-1ion
/147m. \
WCI
81
April 22, I')')J
Isll'rillling
GENERAL LIABILITY
INSURANCE REQUIREM~:NTS
FOR
CONTRACT
HI~TWEIi:N
MONROE COUNTY, FLOfUI>A
AND
AIDS HELP, INC.
Prior to the commencement of work governed by this contract, the Contractor shall obtain
General Liability Insurance. Coverage shall be maintained throughout the life of the conI mct and
include, as a minimum:
· Premises Operations
· Products and Completed Operations
· Blanket Contractual Liability
· PersonallI~ury Liability
· Expanded Definition of Property Damage
The minimum limits acceptable shall be:
$300,000 Combined Single Limit (CSL)
'fsplit limits are provided, the minimum limits acceptable shall be:
$100,000 per Person
$300,000 per Occurrence
$ 50,000 Property Damage
An Occurrcnce Form policy is preferred, 'fcoverage is provided on a Claims Made policy, its
provisions should include coverage for claims filed on or allcr the ellective date of this ,contract.
In addition, the period for which claims may be reported should extend for a minimum of twelve
(12) months following the acceptance of work by the County,
The Monroe County Board ofCounly Commissioners shall be named as Additional'nsul'ed on all
policies issued to satisfy the above requirements,
Adnlini~1rativc J~1ruclion
H470'J.1
GLl
54
April 22, 199]
1st ('rinting
VEHICLE LIABILITY
INSURANCE REQUIREMENTS
IrO ({
CONTRACT
BETWEEN
MONROE COUN1Y, FLORII)A
AND
AIDS HELP, INC.
Recognizing that the work governed by this contract requires the use of vehicles, the Contractor,
prior to the commenccmcnt of work, shall obtain Vchiclc Liability Insurance. Coverage shall be
maintained throughout the life of the contract and include, as a minimum, liability coverage for:
· Owned, Non-Owned, and Hired Vehicles
The minimum limits acceptable shall be:
$100,000 Combined Single Limit (CSL)
If split limits are provided, the minimum limits acceptable shall be:
$ 50,000 per Person
$ 1 00,000 per Occurrence
$ 25,000 Property Damage
The Monroe County Board of County Commissioners shall be named as Additional Insured on all
policies issued to satisfy the above requirements.
Administrnti\'c Instmction
114709.1
VLl
75
April 22. 199.1
1~ll'rilllillg
MEOICAL PROFIGSSIONAL LIABILITY
INSURANCE REQUIREMENTS
FOR
CO~TRACT
nl~T'VEEN
MONROI~ COUNTY, FLORIDA
AND
AIDS HELP, INC.
Recognizing that the work governed by this contract involves the providing of professional
medical treatment, the Contractor shall purchase and maintain, throughout the life of the contract,
Professional Liability Insurance which will respond to the rendering of, or failure to render
medical professional services under this contract.
The minimum limits of liability shall be:
$1,000,000 per Occurrence/$3,OOO,OOO Aggregate
Ifcoverage is provided on a claims made basis, an extended claims reporting period offour (4)
years will be required.
Adrninistralivc InstnJ<.1ion
"'1709.1
ME02
GG
t( Wl:IP
ACCOUNT NO.
47 65 26
POLICY NO.
SUB ACCT NO.
0000
LIBERlYfa
MUTUAL.
Liberty Mutual Insurance Group/Boston
LIBERTY MUTUAL INSURANCE COMPANY 15628
TO/CD SALES OFFICE CODE SALES REPRESENTATIVE
Workers Compensation and
Employers LIability Policy
ISSUING OFFICE 570
INFORMATION PAGE
CODE N/ 1ST YEAR
CI-351-476526-01391/0FORT LAUDERDAL 507 ASSIGNED
Item 1. Name of AIDS HELP, INC.
Insured P.O. BOX 4374
KEY WEST, FL 330~0
000 2
88
Status CORPORA TI ON
Other workplaces not shown above: KEY
APPROVED BY RISK MAN~GEMENT
(;' 'C / ~'l. //
8Y -l,.J
I n q')
N/A ^ YfS
~~~: B #124 SUITE 314 TRUMAN ANNEX
FEIN 592678740
Address
om:
Item 2. Policy Period: From
Mo. Day Vear
12 11 93
12:01 AM
Mo. Day Vear
to 1 2 1 1 9 4
standard time at the address of the insured as stated herein.
Item 3. Coverage
A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states
listed here:
FL
B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A.
of our liability under Part Two are:
Bodily Injury by Accident $ 1 0 0 , 0 0 0 each accident
Bodily Injury by Disease $ 50 0 , 0 0 0 policy limit
Bodily Injury by Disease $ 1 0 0 , 0 0 0 each employee
C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here:
ALL STATES EXCEPT THOSE LISTED IN ITEM 3A AND THE STATES OF
CA CO LA MA MN MS MT ND NM NV NY OH OK TX UT WA WI WV WY PR AK
The limits
D. This policy includes these endorsements and schedules: SEE EXTENSION OF INFORMATION PAGE
Item 4. Premium - The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates
and Rating Plans. All information required below is subject to verification and change by audit.
Premlum Basis Rates LINE 110
Estimated Per S100 Estimated
Qassifications Code Total Annual of Reo Annual
No. Remuneration muneraUon Premiums
SEE EXTENSION OF INFORMATION PAGE
Minimum Premium $ 194 ( F L ) Total Estimated Annual Premium $
Interim adjustment of premium shall be made: ANN U ALL Y Deposit Premium $
*N*9NOO* ARC 232
This policy, including all endorsements issued therewith, is hereby countersigned
5,532
5,532
THIS PROPOSED RENEWAL POLICY
WILL NOT TAKE EFFECT UNLESS
THE POLICY PREMIUM IS PAID BY
12/11/93
[:,;81:: igU1t. & Loss Control
DA'i.'c ---L:2. -/3 -'13
i1':~':'~A L .. .._.... '::ft3 Ot......
Term. Oper. H A
1 8/16/93
RENEWAL OF
WCI-351-476526-012
GPO 4030 RI
Copyright 1987 National Council on Compensation Insurance
we 00 00 01 A
It
X 07/16/93
THIS CERTIFICATE IS ISSUED AS A MAHER 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,
A"""""~:-' "~
~v't,':J;, ~",t!loJo)
CERTIFiCP,Tt: OF INSURANCE
PRODUCER
TilE PORTER ALLEN CONPANY
513 SOUT][ARD STREET
KEY liEST FLm~ LDA 33040
ISSUE DATE (MMIDD/YY)
COMPANIES AFFORDING COVERAGE
f~~~~Y A FRONTIER INSUfu\NCE CONPANY OF NEW YORK
INSURED
f~T~~~NY B FRONTIER
AIDS llELP, INC.
PO HOX 4374 (2700
KEY WEST, FLORIDA
7 --;,;20 - '1_3
vk/j vF f -J/
COVERAGES vV I p~~ -.---
THIS IS TO CERTIFY THAT THE POLlCIU; OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE ~OR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY IlL(lUIIlEMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CEIHIJ-ICATE MAY BE ISSUED OH MAY !'(,HTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE l)9R~
EXCLUSIONS AND CONDITIONS OF suell POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. '~g.. Ij.x
l- 11:
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION lIMITS'L
L TR DATE (MM/DDIYY) DATE (MMIDD/YY)
COM13INED SINGLE $
LIMIT
130DIL Y INJURY $
(Por person)
130DIL Y INJURY $
(Por accident)
~"' PROPERTY DAMAGE $
'V.;:..<v ~.__. - __. - _. _n____ ______
EACH OCCURRENCE $
~~. AGGREGATE
~\~v;. $
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL -.lQ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON T~HCO PANY, ITS AGENTS OR R.PRESENTATIVES.
AUTHORIZED REPRESENTATIVE "...-----~C~u.i A"N\. c:S( .
PERMISSION GRANTED BY PI ');.4(~~1jJ;'
f~T~~NY C
FLAGLER)
33040
f~T~~~lNY D
COMPANY E
LETTER
GENERAL LIABILITY
A XX COMMERCIAL GENEHAL L1A13IL1TY
Ml'S-C002692-00
03-21-93
03-21-94
CLAIMS MADE
OCCUI1.
OWNElrs & COtHHACT Oil'S PilOT.
AUTOM013ILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCIILOULED AUTOS
HillED AUTOS
NOII.OWNED AUTOS
GAIlAGE lIA13IL1TY
EXCESS LIABILITY
IJMIJRELLA FOIlM
OTHER THAN UMlJllELLA FOflM
WORKER'S COMPENSATION
AND
U1PLOYERS'lIABllITY
OTHEIl
B
PROFESSIONAL LIABILITY
FOPL 00 01 70 03-21-93 03-21-94
DESCRIPTION 01 OPEIlATIONS/LOCATIONS/VEIIICLLS/SPECIAL ITEMS
. CERTIFICATE HOLDER
CAN CELLA TION
ff
MONIWI~ COUNTY
HOARD OF COUNTY CO~~ISSIONERS
5100 COLLEGE ROAD
KEY WEST FLORIDA J30~0
ACORD 2~-S (7/90)
GENERAL AGGREGATE $1,500,000.
PRODUCTS-COMP/OP AGG. $ INCLUDED
PERSONAL & ADV. INJURY $500,000.
EACH OCCURRENCE $ 500,000.
FIRE DAMAGE (Anyone liro) $ 50,000.
MED. EXPENSE(Anyoncp"rso~).$..___S ,_000.._.___.
STATUTORY LIMITS
EACH ACCIDENT
DISEASE-POLICY LIMIT
$
$
DISEASE-EACH EMPLOYEE $
PER OCCURRENCE $500,000.
GENERAL AGGREGATE $1,500,00C
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ID:2125870163
NOV 18'93
12:04 No.012 P.Ol
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DATE ._...L.2_::_J~ 13
INI11AL__._~
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POLICY NUMBER: MPS-C002692-00
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED-DESIGNATED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
Name of Person or Organization:
ANY AND ALL FUNDING SOURCES WITH RESPECT TO INSURED'S OPERATIONS.
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown In the
Schedule as an insured but only with respect to liability arising out of your operations or premises owned by or
rented to you,
/
CG 202611 85
Copyright, Insurance ~ervices Office, Inc., 1984
o
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"it Plinling
MONI~(m COUNTY, FLORIDA
't(!tlllCNt 14'01' Wnh'cr
of'
IUNlll'llllCC Rcclllh'cmc,m(s
It is rC<llIcslCd lhallhc Insurance 'yquil'clHcnls, liS specified in lhe Counly's Schedule or Insurance
Rcquil'CIllClIlS, be waived or modilied olllhc following eonll'act.
AIDS Help, Inc.
COlllmclOl':
93-94, services to Monroe County AIDS/ARC residents
COnll'C1cl for:
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Address of COlllrnC10I':
2700 Flagler Avenue
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P.O. Box 4374
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Key West, FL 33041
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Phone:
(305) 296-6196
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Scape of Work:
Services under this contract will include direct financial assistance for rent,
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utilities and food.
Rcason for Waiver;
MEDICAL PROFESSIONAL LIABILITY We do not provide direct medical services.
Social workers manage each client case, referring to local providers as needed.
We currently have professional liability coverage for social workers.
Risk Managemenl
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Approvcu r;.,... Nul AI)Pl'ovcd _. _"
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Dnle
C()lInly Achnilli!:ilnalOl' appcal:
,
. Appru\'\::d:
Not Approvod:
Dille:
Uonrd (11' COIIIlI~' ('(lIIl1l1lllSioncrs appeal:
Approved: .
NOI Approved: .."u___..
Meetillg Dale:
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