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Backup Documents 04/22/2014 Item #16E5
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 E5 TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later than Monday preceding the Board meeting. **NEW** ROUTING SLIP Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office. Route to Addressee(s) (List in routing order) Office Initials Date 1. 2. 3. County Attorney Office County Attorney Office n / q2e_0((q- 4. BCC Office Board of County T Commissioners 5. Minutes and Records Clerk of Court's Office .z 19.11► -It3 PRIMARY CONTACT INFORMATION Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees above,may need to contact staff for additional or missing information. Name of Primary Staff e ^ Phone Number Contact/ Department N 1 Ct / ft S c95a- n1 9 Agenda Date Item was Agenda Item Numbe Approved by the BCC — — - I I C Type of Document Number of Original Attached Acy-2szv∎A >`fvk-S . Documents Attached — PO number or account v `t1 number if document is to be recorded INSTRUCTIONS & CHECKLIST Initial the Yes column or mark"N/A" in the Not Applicable column,whichever is Yes N/A(Not appropriate. (Initial) Applicable) 1. Does the document require the chairman's original signature? 1✓"tb 2. Does the document need to be sent to another agency for additional signatures? If yes, CAW- provide the Contact Information(Name;Agency;Address; Phone)on an attached sheet. 3. Original document has been signed/initialed for legal sufficiency. (All documents to be signed by the Chairman,with the exception of most letters,must be reviewed and signed , by the Office of the County Attorney. 4. All handwritten strike-through and revisions have been initialed by the County Attorney's cNi (�,- Office and all other parties except the BCC Chairman and the Clerk to the Board l 5. The Chairman's signature line date has been entered as the date of BCC approval of the document or the final negotiated contract date whichever is applicable. CAVItr 6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's signature and initials are required. crA 7. In most cases(some contracts are an exception),the original document and this routing slip should be provided to the County Attorney Office at the time the item is input into SIRE. IV /A— Some documents are time sensitive and require forwarding to Tallahassee within a certain time frame or the BCC's actions are nullified. Be aware of your deadlines! 8. The document was approved by the BCC on enter date)and all changes made during the meeting have been incorporated in the atta document. The County tdij Attorney's Office has reviewed the changes,if applicable. 14 9. Initials of attorney verifying that the attached document is the version approved by t i BCC,all changes directed by the BCC have been made,and the document is read or the �r Chairman's signature. I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12 16E5 MEMORANDUM Date: June 27, 2014 To: Maria Franco, Administrative Assistant EMS Operations From: Teresa Cannon, Deputy Clerk Minutes & Records Department Re: Agreement for Field Internship Experience — Edison State College and Medical Career Institute Attached is a copy of the agreement referenced above, (Item #16E5) approved by the Board of County Commissioners on Tuesday, April 22, 2014. The original agreements will be held in the Minutes and Records Department for the Board's Official Record. If you have any questions, please contact me at 252-8411. Thank you. Attachment 16E5 AGREEMENT FOR FIELD INTERNSHIP EXPERIENCE By and Between MEDICAL CAREER INSTITUTE AND BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA Agreement#14-6285 THIS AGREEMENT entered into this Z2 day of `�-� l , 2014, by and between Medical Career Institute, 27975 Old US 41 Rd, Ste 201, Bonita Springs, FL 34135 ("MCI") and the Board of County Commissioners of Collier County, Florida, on behalf of the Collier County Emergency Medical Services Department (CCEMS). WITNESSETH: WHEREAS, MCI provides Emergency Medical Services Technology Programs as a part of it curriculum for its enrolled students; and WHEREAS, MCI desires to augment said programs by providing skill training/field experiences for its students through the association of certain of its student with the activities and practices of the CCEMS, and WHEREAS, CCEMS has the ability to assist MCI in said Program endeavors, including providing opportunities for students to observe and perform appropriate Emergency Medical Technician and/ or Paramedic skills under supervision during field experiences ("Field Experiences"); and WHEREAS, the objective of the herein described relationship of the parties is to benefit the community by and through the enhanced education of its students. NOW, THEREFORE, based on the premises and the mutual covenants, conditions and considerations hereafter expressed, the parties agree as follows: Page 1 of 6 16E5 SECTION ONE: Term. This Agreement shall become effective upon signature of the Chair and shall remain in effect for one (1) year. The Agreement may be renewed for three (3) additional one (1) year terms upon mutual written agreement of the parties. This Agreement may be amended only by written agreement of the parties executed with the same formalities as herein expressed. SECTION TWO: Obligation of MCI. MCI and/or its Emergency Medical Services Technology Programs shall: 1. Provide current copies of the Program's objectives, curricula, and course objectives, and field experiences objectives to CCEMS. 2. Provide a schedule of students' related courses/activities to the appropriate personnel of CCEMS. Schedules will include names and identification numbers of students, dates and times of student association/experience(s) with CCEMS and its personnel. 3. Ensure that all students placed in association with CCEMS under this Agreement shall have insurance as set forth in Attachment A, Insurance Requirements, and provide verification of same to CCEMS. Proof of such coverage shall be provided to CCEMS prior to, or upon execution of this Agreement, and prior to any student participating in the Field Experiences. 4. It is understood between the parties that those students participating in this program shall not be deemed to be employees or volunteers of CCEMS the Collier County Board of Commissioners and that CCEMS and the Collier County Board of Commissioners shall not be liable for injury to a participant under Ch. 440, Florida Statutes, Florida's Worker's Compensation law. Collier County is required to maintain workers' compensation insurance in compliance with Ch. 440, Fla. Stat. Page 2 of 6 16E5 5. Neither CCEMS, the Collier County Board of Commissioners, their employees, or agents shall be responsible for the compliance of participants with State or Federally mandated occupations safety laws. As required, MCI shall ensure and document students and interns maintain compliance. 6. All students must complete background screening through Collier County Facilities Management Department at students' expense in compliance with Ordinance No. 04-52, as amended. SECTION THREE: Obligations of CCEMS. The CCEMS shall: 1. Provide opportunities for those qualified students of MCI to observe and perform appropriate Emergency Medical Technician and/ or Paramedic skills under supervision during Field Experiences. 2. Provide for supervision of the herein described students while in association with CCEMS and during Field Experiences, observation and training. SECTION FOUR: Mutual Responsibilities and Goals. The parties shall: 1. Communicate and act cooperatively through meetings and operational plans to plan and evaluate the Field Experience segment of the Emergency Medical Services Technology Programs and assist each other within the limits of their respective professional abilities to ensure a successful Field Experience program for qualified students. Students will be evaluated by CCEMS supervisors on evaluation forms furnished by MCI. Page 3 of 6 16E5 2. Utilize established lines of authority and communication in effectuating this Agreement or addressing/solving problems which may arise in the implementation of this Agreement. SECTION FIVE: Indemnification. To the maximum extent permitted by Florida law, MCI shall indemnify and hold harmless CCEMS, Collier County, its officers and employees from any and all liabilities, damages, losses and costs, including, but not limited to, reasonable attorneys' fees and paralegals' fees, to the extent caused by the negligence, recklessness, or intentionally wrongful conduct of MCI or anyone employed or utilized by MCI in the performance of this Agreement. This indemnification obligation shall not be construed to negate, abridge or reduce any other rights or remedies which otherwise may be available to an indemnified party or person described in this paragraph. This section does not pertain to any incident arising from the sole negligence of Collier County. The duty to defend under this section is independent and separate from the duty to indemnify, and the duty to defend exists regardless of any ultimate liability of MCI, County and any indemnified party. The duty to defend arises immediately upon presentation of a claim by any party and written notice of such claim being provided to MCI. MCI's obligation to indemnify and defend under this section will survive the expiration or earlier termination of this Agreement until it is determined by final judgment that an action against the County or an indemnified party for the matter indemnified hereunder is fully and finally barred by the applicable statute of limitations. SECTION SIX: Termination. 1. At any time, CCEMS staff may refuse any MCI student(s) from participating in the Field Experience including but not limited to: performing observation, ambulance ride time or practice. 2. Either party may terminate this Agreement upon ten (10) days written notice. Page 4 of 6 16E5 IN WITNESS WHEREOF, the parties hereto have executed this Agreement, this z-z-` day of S\ \\ , 2014. ATTEST: BOARD OF COUNTY COMMISSIONERS DWIGHT E. BROCK, CaLERK COLLIER COUNTY, FLORIDA B : �_ chterfronrieputy Clerk Tom Henning, •Attest as t0 signature only. Approved as to form and legality: 111//, Au !41l1 • Colleen M reene Assistant County Attorney ATTEST: Medical Ca to BY. Richard Gonzalez Item# Ilex AgDate enda c1 Date b aR 1 1 Recd 11. Deputy Clerk Page 5 of 6 • . 16E Attachment A Collier County Florida Insurance Requirements Insurance/Bond Type Required Limits 1. ® Worker's Statutory Limits of Florida Statutes, Chapter 440 and all Federal Compensation Government Statutory Limits and Requirements 2. ® Commercial General Bodily Injury and Property Damage Liability (Occurrence Form) patterned after the $1.000.000 single limit per occurrence current ISO form 3. ® Medical Malpractice $ 1,000,000 single limit per occurrence 4. ® Vendor shall ensure that all subcontractors comply with the same insurance requirements that he is required to meet. The same Vendor shall provide County with certificates of insurance meeting the required insurance provisions. 5. ® Collier County must be named as "ADDITIONAL INSURED" on the Insurance Certificate for Commercial General Liability where required. 6. ® Collier County Board of County Commissioners shall be named as the Certificate Holder and the certificate must read "For any and all work performed on behalf of Collier County. NOTE: The "Certificate" should read as follows: For any and all work performed on behalf of Collier County. Collier County Board of County Commissioners, Naples, Florida No County Division, Department or individual name should appear on the Certificate. 7. ® Thirty (30) Days Cancellation Notice required. Page 6 of 6 16E5 A ° CERTIFICATE OF LIABILITY INSURANCE DATE /VYYY) 066/19/1/19/14 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 CONTACT Linda Blackmon NAME: Gryphon Group dba Great Florida Ins (AH/c No.Ext): (239)948-4474 FAc,No): (239)948-4767 7051 Cypress Terrace,#201 ADDRESS: gryphongroup@juno.com Ft.Myers,FL 33907 INSURER(S)AFFORDING COVERAGE NAIC# Phone (239)433-2800 Fax (239)433-7781 INSURER A: Underwriters of Lloyds INSURED INSURER B: Underwriters of Lloyds London Medical Career Institute, Inc INSURER C: 27975 Old 41 Road #201 INSURER D: Bonita Springs,FL 34135- 239 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 TYPE OF INSURANCE INSRLSWVD i POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM/DDIYYYY) (MM/OD/YWY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED � 50 000.00 PREMISES(Ea occurrence) $ ❑ ❑ CLAIMS-MADE in OCCUR MEO1 1 694981 3 MED EXP(Any one person) $ 500,000.00 A n Professional Liability 09/15/2013 09/15/2014 PERSONAL&ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 3,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 0.00 ❑ POLICY ❑ PE8T ❑ LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ❑ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ ❑ AUTOS ❑ AUTOS ❑ HIRED AUTOS ❑ NON-OWNED I (Peer accRTYnDAMAGE ❑ ❑ d �t1) ❑ UMBRELLA LIAB ❑OCCUR '� EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE_ AGGREGATE $ Li DED ❑ RETENTION$ $ WORKERS COMPENSATION Y LIMITS❑_TORY LI ER AND EMPLOYERS'LIABILITY Y/N ----— - ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE$ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ • B Commercial Property AS30013FLP00083 09/11/2013 09/11/2014 ),000.00,$70,000.00 and$25,000 Bus Income DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) 1. 27975 Old 41 Rd Ste 201,Bonita Springs FL 2. 1769 E Moody Blvd,Bunell FL Collier County is named as an Additional Insured for Commercial General Liability. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Collier County Board of Commissioners THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 3327 Tamiami Trail East Naples FL 34112 AUTHORIZED REPRESENTATIVE Email:Mariafranco©colt iergov.net Linda Blackmon ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05)QF The ACORD name and logo are registered marks of ACORD 16E5 AGREEMENT FOR FIELD INTERNSHIP EXPERIENCE By and Between EDISON STATE COLLEGE AND THE COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS THIS AGREEMENT entered into this2Zr4of April 2014, by and between District Board of Trustees Edison State College, Florida located at 8099 College Parkway, Fort Myers, FL 33919 (the "College") and the Collier County Board of County Commissioners, on behalf of the Collier County Emergency Medical Services Department ("CCEMS"). WITNESSETH: WHEREAS, College provides Emergency Medical Services Technology Programs as a part of its curriculum for its enrolled students; and WHEREAS, College desires to augment said programs by providing skill training/field experiences for its students through the association of certain of its student with the activities and practices of the CCEMS, and WHEREAS, CCEMS has the ability to assist College in said Program endeavors, including providing opportunities for students to observe and perform appropriate Emergency Medical Technician and/ or Paramedic skills under supervision during field experiences ("Field Experience(s)"); and WHEREAS, the objective of the herein described relationship of the parties is to benefit the community by and through the enhanced education of its students. NOW, THEREFORE, based on the premises and the mutual covenants, conditions and considerations hereafter expressed, the parties agree as follows: SECTION ONE: Term. This Agreement shall become effective upon approval by the Board of County Commissioners and shall remain in effect for one (1) year. The Agreement may be renewed for three (3) additional one (1) year terms upon mutual written agreement of the parties. This Page 1 of 7 16L5 Agreement may be amended only by written agreement of the parties executed with the same formalities as herein expressed. SECTION TWO: Obligation of College. College and/or its Emergency Medical Services Technology Programs shall: 1. Provide current copies of the Program's objectives, curricula, and course objectives, and field experiences objectives to CCEMS. 2. Provide a schedule of students' related courses/activities to the appropriate personnel of the CCEMS. Schedules will include names and identification numbers of students, dates and times of student association/experience(s) with CCEMS and its personnel. The College participates in a program of shared risk management created by the Florida College System Risk Management consortium (FCSRMC). The College provides professional liability insurance coverage for students participating in externship activities in the amount of two million dollars ($2,000,000.00) per claim/five million dollars ($5,000,000.00) aggregate. Proof of such coverage shall be provided to CCEMS prior to, or upon execution of this Agreement, and prior to any student participating in the Field Experiences. 3. It is understood between the parties that those students participating in this program shall not be deemed to be employees or volunteers of the CCEMS or the Collier County Board of Commissioners and that the CCEMS and the Collier County Board of Commissioners shall not be liable for injury to a participant under Ch. 440, Florida Statutes, Florida's Workers' Compensation law. Collier County is required to maintain workers' compensation insurance in compliance with Ch. 440, Fla. Stat. 4. Neither the CCEMS, the Collier County Board of Commissioners, nor their employees, or agents shall be responsible for the compliance of participants with Page 2 of 7 16E5 State or Federally mandated occupational safety laws. As required, the College shall ensure and document that students and interns maintain compliance. 5. All students must complete background screening through Collier County Facilities Management Department at students' expense in compliance with Ordinance No. 04-52, as amended. SECTION THREE: Obligations of CCEMS The CCEMS shall: 1. Provide opportunities for those qualified students of the College to observe and perform appropriate Emergency Medical Technician and / or Paramedic skills during Field Experiences with department personnel. 2. Provide for direct supervision of the student interns while in association with the CCEMS and during Field Experiences, observation and training. SECTION FOUR: Mutual Responsibilities and Goals. The parties shall: 1. Communicate and act cooperatively through meetings and operational plans to plan and evaluate the Field Experience segment of the Emergency Medical Services Technology Programs and assist each other within the limits of their respective professional abilities to ensure a successful field experience program for qualified students. Students will be evaluated by CCEMS supervisors on evaluation forms furnished by the College. 2. Utilize established lines of authority and communication in effectuating this Agreement or addressing/solving problems which may arise in the implementation of this Agreement. Page3of7 ��, 16E5 SECTION FIVE: Termination. 1. At any time, and at their sole discretion CCEMS staff may refuse any College student(s) from participating in the Field Experiences including but not limited to: performing observation, ambulance ride time or practice. 2. Either party may terminate this Agreement upon ten (10) days written notice. SECTION SIX: Government Regulations To the extent applicable, the parties agree that they will comply with: 1. Title VI of the Civil Rights Act of 1964, as amended, 42 U.S.C. 2000d et seq., which prohibits discrimination on the basis of race, color, or national origin in programs and activities receiving or benefiting from federal financial assistance. 2. Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. 794, which prohibits discrimination on the basis of handicap in programs and activities receiving or benefiting from federal financial assistance. 3. Title IX of the Education Amendments of the 1972, as amended, 20 U.S.C. 1681 et seq. , which prohibits discrimination on the basis of sex in education programs and activities receiving or benefiting from federal financial assistance. 4. The Age Discrimination Act of 1975, as amended, 42 U.S.C. 6101 et seq., which prohibits discrimination on the basis of age in programs or activities receiving or benefiting from federal financial assistance. 5. The Omnibus Budget Reconciliation Act of 1981 , P.L. 97-35, which prohibits discrimination on the basis of sex and religion in programs and activities receiving or benefiting from federal financial assistance. 6. Executive Order 11246 of September 24, 1965 as amended, and of the rules, regulations, and relevant orders of the Secretary of Labor, which prohibit discrimination in government employment on the basis of race, creed, color, or Page 4 of 7 • 16E5 national origin. 7. The Vietnam Era Veteran's Readjustment Assistance Act of 1974, as amended, 38 U.S.C. 219 et seq., covering rehabilitation measures for Vietnam Veterans. 8. The Americans with Disabilities Act of 1990, which prohibits discrimination on the basis of disability and/or perceived disability. 9. Chapter 760, Florida Statutes, which prohibits discrimination on the basis of race, color, religion, sex, national origin, age, handicap, or marital status. 10. Title 45, C. F. R. 160.103, Health Insurance Portability and Accountability Act (HIPAA) which governs privacy regulations associated with medical information. 11. All regulations, guidelines, and standards which are now or may be lawfully adopted under the above statutes, as well as any other federal, state, or local rules, regulations and ordinances. SECTION SEVEN: Equal Opportunity The College is committed to providing an educational and working environment free from discrimination and harassment. All programs, activities, employment and facilities of the College are available to all on a non-discriminatory basis, without regard to race, sex, age, color, religion, national origin, ethnicity, disability, sexual orientation, marital status, genetic information or veteran's status. The College is an equal access/equal opportunity institution. Questions pertaining to educational equity, equal access, or equal opportunity should be addressed to: College Equity Officer, Office of Human Resources, 8099 College Parkway, Fort Myers, FL 33919, (239) 489-9293. SECTION EIGHT: Indemnification Each party agrees to indemnify, defend and hold harmless the other, its officers, board members, agents and employees from and against any and all fines, suits, claims, demands, penalties, liabilities, costs or expenses, losses, settlements, judgments and awards and actions Page 5of7 E5 of whatever kind or nature, including attorney's fees and costs (and costs and fees on appeal), and damages (including, but not limited to, actual and consequential damages) arising from any negligent, willful or wrongful misconduct, knowing misrepresentation or breach of this Agreement by such party, its officers, board members, agents or employees. This paragraph shall not be construed in any way to alter the State's waiver of sovereign immunity or extend the parties liability beyond the limits established in Section 768.28, Florida Statutes and in no event shall either parties be liable to [ay a claim or a judgment by any one person which exceeds the sum of two hundred thousand dollars ($200,000.00) or any claim or judgment, or portions thereof, which, when totaled with all other claims or judgments paid arising out of the same incidents or occurrence, exceeds the sum of three hundred thousand dollars ($300,000.00). *********************Remainder of page intentionally left blank************************************* Page 6 of 7 0 GP 16E5 IN WITNESS WHEREOF, the parties hereto have executed this Agreement, this-aw1 Jay of , 2014. ATTEST: BOARD OF COUNTY COMMISSIONERS DWIGHT E. BROCK, CLERK COLLIER COUNTY, FLORIDA Attest as tt5 Chairman's , Deputy Clerk Tom Hen► g, Chairman signature Only. Approved as to form and legality C4tAAN olleen M. Green: Assistant County Attorney ATTEST: Edison State College BY: Dr. Gina ODeble p mtn envier Name, Title Name, Title 7i afe! APPROVED t:IOFOBM: Ad BY: k 4 ice • .rai Co -1 t Ien# irons bgenda ::'iiL' Id� 0 '4 Clerk 1>'n!e Page7of7 16E5 DATE(MM/DD/YYYY) AR D CERTIFICATE OF LIABILITY INSURANCE 06/24/2014 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 1-800-524-0191 CONTACT Johanne Daguillard NAME: Arthur J. Gallagher Risk Management Services, Inc. PHONE 407-563-3535 FAX 407-370-3057 _(A/C.No.Ext): (A/C,No): 200 S. Orange Ave ADDRESS: johanne_daguillard @ajg.com Suite 1350 Orlando, FL 32801 INSURER(S)AFFORDING COVERAGE NAIC# Peter Doyle INSURER A: AMERICAN CAS CO OF READING PA 20427 INSURED INSURER B: Students of the Allied Health Sciences Courses of the Participating Colleges of the Florida College System Risk INSURERC: Management Consortium INSURER D: 4500 NW 27th Avenue, Suite D2 Gainesville, FL 32606 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 40364169 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ RO- POLICY j1 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Student Professional 0127291333 08/26/13 08/26/14 Each Claim 2,000,000 Liability Aggregate 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Edison State College Student Clinical Experience. Coverage includes College Faculty Members for instruction/supervision of students only. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Collier County Board of County Commissioners THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 3311 Tamiami Trail East AUTHORIZED REPRESENTATIVE Naples, FL 34112 "a 14 USA ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD lathaorla 40364169