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Backup Documents 09/28/2021 Item #16H 1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO it L Li THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATU V fl 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. Risk Risk Management V Z8/2-/ 2. County Attorney Office County Attorney Office ,, 1627/1-61 4. BCC Office Board of County � l Commissioners J �/ to.. _-►4. Minutes and Records Clerk of Court's Office111 K KY-2rI raga pn\.. 5. Procurement Services Procurement Services i 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 Ana Reynoso/PURCHASING Contact Information 239-252-8950 Contact/Depat lment Agenda Date Item was September 28,2021 Agenda Item Number 16.H.1. Approved by the BCC Type of Document CONTRACT Number of Original 1 Attached Documents Attached PO number or account N/A 11-5776-NS Martha U Coburn, number if document is Martha U Coburn, M.D. Florida to be recorded M.D. Florida District Twenty District Twenty Medical Examiner Medical Examiner _ 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 STAMP OK N/A 2. Does the document need to be sent to another agency for additional signatures? If yes, N/A 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 AR 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 N/A Office and all other parties except the BCC Chairman and the Clerk to the Board 5. The Chairman's signature line date has been entered as the date of BCC approval of the AR document or the fmal negotiated contract date whichever is applicable. 6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's AR signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip N/A should be provided to the County Attorney Office at the time the item is input into SIRE. 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 09/28/2021 and all changes made during N/A is not the meeting have been incorporated in the attached document. The County for Attorney's Office has reviewed the changes,if applicable. -. - E ;t.. 9. Initials of attorney verifying that the attached document is the version approved by the - p �t BCC,all changes directed by the BCC have been made,and the document is ready for the , ,'' an�option for Chairman's signature. 'is N anagement 16Hi ELEVENTH AMENDMENT TO AGREEMENT NO. 11-5776 FOR MEDICAL EXAMINER SERVICES THIS ELEVENTH AMENDMENT TO AGREEMENT NO. 11-5775 FOR MEDICAL EXAMINER SERVICES (the "Amendment") is entered into and is effective on this 1st day of October, 2021, by and between Marta U. Coburn, M.D., Florida District Twenty Medical Examiner for Collier County, Florida, doing business as District 20 Medical Examiner, Inc., a Florida for Profit Corporation (hereinafter called"Medical Examiner") and the Board of County Commissioners of Collier County, Florida(hereinafter called"County"),collectively referred to as the"parties." RECITALS: WHEREAS, the parties entered into an Agreement No. 11-5775 for Medical Examiner Services (the "Agreement") dated September 27, 2011, a copy of which is attached hereto; and WHEREAS, the Board approved the Ninth Amendment to the Agreement on September 22, 2020 (Agenda Item 16.E.1), with the Tenth Amendment being administratively approved on October 7, 2020, to correct the payment ending date from September 30, 2020 to September 30, 2021; and WHEREAS, the parties wish to extend the term of the Agreement and to clarify their respective responsibilities for certain costs relating to County-allocated charges consisting of Information Technology costs as well as General, Property, and Liability insurances pertaining to the Medical Examiner's Facility. WITNESSETH: NOW, THEREFORE, in consideration of Ten Dollars ($10.00) and other good and valuable consideration exchanged amongst the parties, and in consideration of the covenants contained herein, the parties agree as follows: 1 Amendment#11 to Contract 11-5776 CAO l � H1 1. All of the above RECITALS are true and correct and are hereby expressly incorporated herein by reference as if set forth fully below. 2. Section I of the Agreement is hereby amended by extending the term of the Agreement from October 1, 2021 through September 30, 2022. 3. Section III, Paragraph A of the Agreement is replaced in its entirety to now read as follows: "The County hereby agrees to compensate the Medical Examiner for services to be performed for the term of this Agreement, beginning on October 1, 2021, the amount of One Million Eight Hundred Forty-Eight Thousand Seven Hundred Dollars ($1,848,700) by semimonthly payments ending September 30, 2022. In addition, the County will make payments on behalf of the Medical Examiner for County-allocated charges consisting of Information Technology costs, as well as General, Property, and Liability insurances in total of Fifty-Three Thousand Nine Hundred Dollars ($53,900). Any modifications to this Contract shall be in compliance with the County Procurement Ordinance and Procedures in effect at the time such modifications are authorized. 4. Except as modified by this Amendment, the Agreement shall remain in full force and effect. If there is a conflict between the terms of this Amendment and the Agreement, the terms of this Amendment shall prevail. (Signature Page to Follow) 2 CAO Amendment#11 to Contract 11-5776 l6Hi IN WITNESS WHEREOF, the parties executed this Eleventh Amendment by their authorized agents as of the date first above written. ATTEST: BOARD OF COUNTY COMMISSIONERS Crystal K. Kinzel, Comptroller and COLLIE 0 TY, FLORIDA Clerk of Courts L*114- By: 0 C • By 12/11A(9 : ,� eputy Clerk PENNY TAYLOR, Chair Attest to PirrinanN signature only, , Approved as to Form and Legality: By: tP/4-- c ott R. Teach Deputy County Attorney MEDICAL EXAMINER By 67-1L4C41k AA) Marta U. Coburn M.D. Medical Examiner Florida District Twenty 3 CAO Amendment#11 to Contract 11-5776 6H1 AGREEMENT FOR MEDICAL EXAMINER SERVICES THIS AGREEMENT FOR MEDICAL EXAMINER SERVICES, (Agreement), made and entered into this 27th day of September , 201.1., by and between Marta U. Coburn, M.D., Florida District Twenty Medical Examiner for Collier County, Florida, doing business as District 20 Medical Examiner, a Florida for Profit Corporation, (hereinafter called "Medical Examiner"), and the Board of County Commissioners of Collier County, Florida, (hereinafter called "County"). Medical Examiner and County are hereinafter collectively referred to as the "parties." WHEREAS, Dr. Marta U. Coburn was re-appointed Florida District Twenty Medical Examiner for Collier County, Florida, on August 18, 2011, by Rick Scott, Governor of the State of Florida; and WHEREAS, Section 406.06(2), Florida Statutes, provides that the District Medical Examiner may appoint Associate Medical Examiner(s) to provide medical examiner services at all times and all places within the district and that said Associate Medical Examiner(s) shall serve at the pleasure of the District Medical Examiner; and WHEREAS, Section 406.06(3), Florida Statutes, states that District Medical Examiner(s) and Associate Medical Examiner(s) shall be entitled to compensation and such reasonable salary and fees as are established by the Board of County Commissioners in their respective district; and WHEREAS, Section 406.08(1),Florida Statutes, provides that fees, salaries and expenses for the Medical Examiner's office may be paid from the general funds or any other funds under „ . H1 the control of the Board.of County Commissioners and that the Medical Examiner shall submit an annual budget to the Board of County Commissioners; and. WHEREAS, Section 406.08(5), Florida Statutes, provides that autopsy and laboratory facilities utilized by the District Medical Examiner or Associate Medical Examiner(s) may be provided on a permanent or contractual basis by the counties within the district; and WHEREAS, Collier County desires to contract with Marta U. Coburn, M.D., Florida District Twenty Medical Examiner, doing business as District 20 Medical Examiner, Inc., a Florida Corporation, to provide medical examiner services under Chapter 406, Florida Statutes, as an independent contractor. NOW, THEREFORE, in consideration of the mutual covenants, terms, conditions and provisions contained herein,the parties do hereby agree as follows: SECTION I TERM OF AGREEMENT The term of this Agreement shall be from October 1, 2011 through September 30, 2012. SECTION II PURPOSE AND SCOPE OF CONTRACTUAL SERVICES The Medical Examiner hereby agrees to furnish services, labor and all equipment not otherwise provided for, necessary for the complete performance of the services contemplated hereunder, to wit: to serve as Florida District Twenty Medical Examiner for Collier County, Florida in accordance with Chapter 406, Florida Statutes, and the standards promulgated by the Florida Medical Examiner's Commission. 2 l �6 H SECTION III COMPENSATION AND PAYMENTS A. The County hereby agrees to compensate the Medical Examiner for services to be performed for the term of this Agreement, beginning on October 1, 2011, the amount of one million twenty-three thousand eight hundred dollars ($1,023,800) by semimonthly payments ending September 30, 2012. B. Payments from the County to the Medical Examiner of the compensation set forth in paragraph. A, above, shall be made on the 15th and 30th days of each month. If the 15th or 30th of the month falls on a weekend or a holiday, the payment to the Medical Examiner shall be made on the next County business day. It is expressly understood that each semimonthly payment shall be made for the services furnished for the preceding period of time. As a condition of said semimonthly payment by the County, the Medical Examiner shall be in full compliance with Section VII of this Agreement regarding reports. C. The Medical Examiner agrees and understands that under the terms of this Agreement, a full professional staff (associate medical examiner(s) and autopsy technician(s)) must be maintained in order to perform the Medical Examiner duties set forth under this Agreement and by Chapter 406, Florida Statutes, D. The County agrees and understands that the compensation provided for under this Agreement to the Medical Examiner is intended to cover the anticipated normal activities/workload of the Medical Examiner, based upon past statistics and reasonable projections. The County acknowledges and agrees that the semimonthly compensation of the Medical Examiner set forth in this Section has been established without consideration of disasters or occurrences of an unusmil nature or magnitude such as would necessitate extraordinary expenditure on the part of the Medical Examiner in fulfilling the obligations under I H this Agreement and Chapter 406, Florida Statutes. In the event of such disaster(s) or occurrence(s), the Medical Examiner shall consult with and shall seek, but not necessarily obtain, the approval of the Collier County Emergency Management Director or his/her designee, for any additional expenditures. The Medical Examiner shall in all events retain the right to and shall then petition the Board of County Commissioners to reimburse the Medical Examiner for all extraordinary expenses and compensation which are justified and incurred by the Medical Examiner due to said disaster(s) or occurrence(s). The Medical Examiner shall provide invoices and receipts in an itemized manner to support the petition to the Board of County Commissioners for extraordinary compensation and expenditures. Examples of extraordinary disasters or occurrences include,but are not limited to: aircraft,bus and boat accidents where a simultaneous large loss of life has occurred; hurricanes and other natural disasters; and any other disasters or occurrences caused by nature or man-made where a large loss of life is experienced. Upon petition of the Medical Examiner for extraordinary compensation and/or expenditures, and with the recommendation of the Collier County Emergency Management Director, the Board of County Commissioners shall determine, using a reasonable and objective standard, if extraordinary compensation and/or expenditures shall be paid to the Medical Examiner. SECTION IV FACILITIES AND EQUIPMENT A. In accordance with Section 406.08(5), Florida Statutes, the County agrees to provide and insure, at no cost to the Medical Examiner, a facility and all medical/laboratory related equipment reasonably required. by the Medical Examiner to perform the duties as District Medical Examiner. All costs associated with maintaining the facility and its area landscaping will be paid by the Medical Examiner. The County shall bear the cost of the Medical Examiner's facility. 4 16H1 B. All capital equipment needed and budgeted by the County for use by the Medical Examiner shall be purchased by, and be inventoried through, the County as County property, The procurement of said equipment shall be approved by the Collier County Emergency Management Director in accordance with the Collier County' Purchasing Policy, upon submission of a requisition by the Medical Examiner. The Medical Examiner agrees to take reasonable care with and maintain and repair any equipment provided by the County. The County agrees to include all equipment reasonably required by the Medical Examiner in the annual medical examiner budget submitted to the Board of County Commissioners for approval. C. Except as otherwise provided in this Agreement, the Medical Examiner shall be solely responsible for the payment of all normal and ordinary services, fees, and costs • encumbered in the course of the Medical Examiner's office's operation. SECTION V PROFESSIONAL LI.ABILITY INSURANCE Pursuant to Section 406.16, Florida Statutes, the County shall pay the Medical Examiner's professional liability insurance. This payment shall be in addition to the semimonthly compensation paid to the Medical Examiner by the County under Section III of this Agreement. As a condition precedent to the County paying for the, Medical Examiner's professional liability insurance, the Medical Examiner shall present to the County an original invoice evidencing the purchase by the Medical Examiner of said insurance coverage. SECTION VI USE OF FACILITIES AND EQUIPMENT BY THE MEDICAL EXAMINER FOR HUMANITARIAN AND/OR CHARITABLE PURPOSES The Medical Examiner shall be allowed to use the County's facility and laboratory equipment for humanitarian and/or charitable purposes provided that these purposes in no way interfere with the Medical Examiner's primary duty to serve as medical examiner for Collier 5 H County. As provided in Section 406.16, Florida Statutes, the County shall not be liable for any acts of the Medical Examiner not within the scope of the official duties performed for Collier County. The performance by the Medical Examiner of humanitarian and/or charitable services under this paragraph shall not be considered part of the official duties of the Medical Examiner. SECTION VII REPORTS The Medical Examiner agrees to provide to the County quarterly reports which shall include, minimally the following: A. Number of all investigations and narrative reports for non-autopsy medical examiner cases; B. Number of all autopsies performed; C. Court cases and medical/legal conferences,number and hours spent; D. Number of authorizations for all cremations and burials at sea and anatomical dissections; E. Number of hours of scene investigations; F. Any other activities not described above. The quarterly report shall be submitted by the 10th day of the month to the County's Emergency Management Director. SECTION VIII MEDICAL EXAMINER AS INDEPENDENT CONTRACTOR A. It is hereby stated to be the expressed intent of the parties"that under this Agreement the Medical Examiner shall act exclusively as an independent contractor rendering professional services for the County in accordance with Chapter 406, Florida Statutes, and the Medical Examiner shall not be considered as an employee or agent of the County. The Medical Examiner shall be solely responsible for the payment of all applicable taxes for compensation paid to the Medical Examiner by the County pursuant to this Agreement. The Medical Examiner shall not be eligible for, nor participate in, any fringe benefits from the County. 6 1 Hi B. The Medical Examiner shall be responsible for employing and providing by separate Agreement, independent of the County, all personnel or other services necessary for the performance of the duties and responsibilities under this Agreement and in accordance with Chapter 406, Florida Statutes. The Medical Examiner shall have complete supervision and control over said employees who shall not be entitled, as a result of this Agreement, to any benefits granted employees of the County. C. Pursuant to Section 406.16, Florida Statutes, the County shall not be liable for any acts of the Medical Examiner that are not within the scope of the official duties as Medical. Examiner. SECTION IX NO PARTNERSHIP Nothing contained in this Agreement shall create or be construed as creating a partnership between the County and the Medical Examiner. SECTION X NO DISCRIMINATION The Medical Examiner agrees that there shall be no discrimination as to race, sex, color, creed or national origin at any County facilities provided under this Agreement and with regard to the provision of the services of the Medical Examiner contemplated by this Agreement. SECTION XI COMPENSATION FOR MEDICAL EXAMINER EXPERT TESTIMONY IN COLLIER COUNTY CRIMINAL PROCEEDINGS In accordance with the provisions of Chapter 29, Florida Statutes, as amended by Senate Bill 2962, effective July 1, 2004, all fees for expert testimony of the Medical Examiner in criminal proceedings shall be paid by the State of Florida. Upon perfoLluance of service, the Medical Examiner shall submit its fee for service to the appropriate State agency or court- appointed counsel. I6Hi H SECTION XII NOTICES All notices from the County to the Medical Examiner shall be deemed duly served if mailed by certified mail to the Medical Examiner at the following address: Office of the Medical Examiner 3838 Domestic Avenue Naples, FL 34104 All notices from the Medical Examiner to the County shall be deemed duly served if mailed by certified mail to the County at the following address: Collier County Emergency Management Director 8075 Lely Cultural Pkwy, Suite 445 Naples, Florida 34113 The County and the Medical Examiner may change the above mailing addresses at any time by giving the other party written notification within fifteen (15) days of said mailing address change. All notices under this Agreement must he in writing. SECTION XIII NO IMPROPER USE The Medical Examiner will not use, nor suffer or permit any person to use in any mariner whatsoever, County facilities for any improper, immoral or offensive purposes, or for any purpose in violation of any federal, state, county, or municipal ordinance, rule, order or regulation, or of any governmental rule or regulation now in effect or hereafter enacted or adopted. In the event of such violation by the Medical Examiner or any staff of the Medical Examiner, the County shall have the right to suspend this Agreement with the Medical Examiner. Should the Medical Examiner fail to correct any such violation within twenty-four (24) hours after receiving notice of such violation, such suspension shall continue until the violation is cured. a i6Hi SECTION XIV INDEMNIFICATION The Medical Examiner shall hold harmless and defend Collier County and its agencies and employees from all suits and actions, including attorney fees and all costs of litigations and judgments of any name and description arising out of, or incidental to, the performance of this Agreement or services performed hereunder. The Medical Examiner's obligation pursuant to this provision shall not be limited in any way by the agreed-upon compensation under this Agreement or the Medical Examiner's limit of, or lack of, sufficient insurance protection. This section does not pertain to any incident arising from the sole negligence of Collier County. SECTION XV TERMINATION AND CONTINUITY OF SERVICES A. This Agreement may be terminated by either party upon ninety (90) days written notice to the other party by certified mail, return receipt requested. The parties shall deal with each other in good faith during the ninety-day period after any notice of any intent to terminate has been given. Either party may terminate this Agreement immediately for reasonable cause, upon written notice to the other. Reasonable cause shall include but not be limited to: (1) Material violation(s) of this Agreement; (2) Suspension or revocation of the Medical Examiner's license to practice medicine or other disciplinary actions taken against the Medical Examiner by the Florida Medical Examiners Commission or similar regulatory authority; (3) Revocation of the Medical Examiner's appointment as Medical Examiner for Florida Medical Examiner District Twenty; (4) Any violation of the Medical Examiner's duties as required under Chapter 406, Florida Statutes; (5) Repeated andJor prolonged absence(s) from office substantially affecting the performance of the duties of the Medical Examiner under this Agreement; (6) The death of the Medical Examiner; 9 1 H 1 (7) Physical and/or mental incapacitation of the Medical Examiner substantially affecting the performance of the duties of the Medical Examiner under this Agreement. B. In the event of a termination of this Agreement by the County, the County shall only be required to pay such compensation to the Medical Examiner as she may be entitled to for services performed until the time of termination. SECTION XVI AMENDMENTS This Agreement may be modified by amendment at any time provided that such amendment is in writing and signed by both parties. SECTION XVII ATTORNEY FEES In the event of any litigation arising under this Agreement, the prevailing party shall be entitled to recoup attorney fees and all costs of litigation from the non-prevailing party at both trial and all appellate levels. c 1 6 H 1 IN VvTrNESS WHEREOF, the parties have caused this Agreement to be executed on the day first above written, ATTEST: BOARD OF COUNTY COMMISSIONERS Dwi ht E. Brock, Clerk COLLIER COUNTY, FLORIDA .,. By: .'ePtitY Cf'rk Fred W. Coyle, Chairman ..':AT.i.eirt. al to Ch4 triken s . -;•' i 4Na-0i 'cii 4ii •• . , • , , ,, • • - .'' .:. '''''' ••• ,,•'. . . ' . • First Withess MEDICAL EXAMINER filat...4 .4;;"1-L..g--- Signatureq/Date , - t - i/ Marta U. Coburn, M.D. Medical Examiner Florida District Twenty iir t•or,'e_ C , Fko-ert's 0.,-\ Date: - ,..-46-t 7 tr,7 26' f Typed'6r Printed Name Second Witness Signature/ Date q 1 9 t 2,9 tt Ap oved ts to form and Typed or Printed Name leg ,. i0..s .... i .141, ,It A,J effre',.; A1Iatzkow Counf" A'tc orney 12. 16H1 ACORD® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 2/25/2021 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 NAME: Bouchard Insurance Marsh&McLennan PHONE FAX 101 N Starcrest Dr (A/C.No.Ext):727-447-6481 (A/C,No):727-449-1267 _ Clearwater FL 33765 ADDREss: cicerts@bouchardinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Lloyds of London 10200 INSURED DISTRICT INSURER B: Employers Preferred Insurance Company 10346 District 20 Medical Examiner Marta U. Coburn, MD INSURER C: 3838 Domestic Avenue INSURERD: Naples FL 34104 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1545901091 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. ILTRR TYPE OF INSURANCE IADDL NSD SUBR POLICY EFF POLICY EXP WVD POLICY NUMBER LIMITS (MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE RENTED $ CLAIMS-MADE OCCUR PREMISESO(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY L J PRO JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ AWNED SCHEDULED BODILY INJURY(Per accident) $ \ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION EIG277943402 3/2/2021 3/2/2022 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y N ANYPROPRIETOR/PARTNER/EXECUTIVE yN/A E.L.EACH ACCIDENT $100,000 OFFICER/MEMBEREXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 A Professional Liability ME0108506820 11/30/2020 11/30/2021 $1,000,000/claim $3,000,000/agg DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Proprietors/Partners/Executive Officers/Members Excluded: Marta U Coburn,MD,Owner CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN COLLIER COUNTY BOARD OF COUNTY ACCORDANCE WITH THE POLICY PROVISIONS. COMMISSIONERS 3327 TAMIAMI TRAIL EAST AUTHORIZED REPRESENTATIVE NAPLES FL 34112 Jeckt urt ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD