#11-5734 (Golisano Children's Museum of Naples, Inc.)
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Coumy
Dvision
Purchasing Department
3327 Tamiami Trail East
Naples, Florida 34112
Telephone: (239) 252-2667
FAX: (239) 252-6593
Email: LynWood@.collierqov.net
www.collierqov.netlpurchasinq
Memorandum
Subject:
Contract #11-5734 "2012 Tourism Agreemenf'
Date:
September 27,2011
From:
Diana De Leon for Lyn M.Wood, C.P.M, Procurement Strategist
To:
Ray Carter, Risk Manager
This Contract was approved by the BCC on September 27,2011 Agenda Item 16.F.7
The County is in the process of executing this contract with Golisano Children's Museum of Naples, Inc.
Please review the Insurance Certificate(s) for the referenced Contract.
. If the insurance is not in order. please contact the vendor/insurance company to obtain a
proper certificate. Once you receive the proper certificate(s), please acknowledge your approval
and send to the County Attorney's office via the attached Request for Legal Services.
. If the insurance is in order. please acknowledge your approval and send to the County
Attorney's office via the attached Request for Legal Services.
If you have any questions, please contact me at the above referenced information.
nature
/t/z/ h
Date
C: Jack Wert, Tourism
(Please route to County Attorney via attached Request for Legal Services)
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G/Acquisitions/AgentFormsandLetters/RiskMgmtReviewofl nsurance4/15/201 0/16/09
2012 TOURISM AGREEMENT BETWEEN
COLLIER COUNTY AND THE GOLISANO CHILDREN'S MUSEUM OF NAPLES,
INe.
THIS AGREEMENT, is made and entered into this 'd.. 7ft, day of
~ p-4 '^^ ~.lVr- , 2011, by and between the Golisano Children's Museum of
Naples, Inc., a Florida not-for-profit corporation, hereinafter referred to as "GRANTEE" and
Collier County, a political subdivision of the State of Florida, hereinafter referred to as
"COUNTY".
WHEREAS, the COUNTY has adopted a Tourist Development Plan (hereinafter referred
to as "Plan") funded by proceeds from the Tourist Development Tax; and
WHEREAS, the Collier County Tourism Ordinance provides that certain of the revenues
generated by the Tourist Development Tax are to be allocated to acquire, construct, extend,
enlarge, remodel, repair, improve, maintain, operate or promote museums owned and operated
by not-for-profit organizations and open to the public; and
WHEREAS, GRANTEE has applied to the Tourist Development Council and the County
to use Tourist Development Tax funds for GRANTEE'S out of county marketing expenses; and
WHEREAS, the Tourist Development Council has recommended funding for the
GRANTEE'S out of market advertising and related marketing and promotion expenditures; and
WHEREAS, the Board of County Commissioners has made a finding that GRANTEE
qualifies as a museum; and
WHEREAS, the Collier County Board of County Commissioners has approved the
funding request of the GRANTEE and the Chairman was authorized to execute the Tourism
Agreement.
NOW, THEREFORE, BASED UPON THE MUTUAL COVENANTS AND PREMISES
PROVIDED HEREIN, AND OTHER VALUABLE CONSIDERATION, IT IS MUTUALLY
AGREED AS FOLLOWS:
1. SCOPE OF WORK:
(a) In accordance with the authorized expenditures as set forth in the Budget,
attached hereto as Exhibit "F", the GRANTEE shall expend the funds for the promotion of
GRANTEE'S events and exhibits (hereinafter "the Project").
1
2. PAYMENT:
(a) The amount to be paid under this Agreement shall be a total of One Hundred
Thousand Dollars ($100,000). GRANTEE shall be paid in accordance with the fiscal procedures
of the County for the expenditures incurred as described in Paragraph One (1) herein upon
submittal of a Request for Funds on the form attached hereto as Exhibit "D" and made a part
hereof, and shall submit vendor invoices, copies of credit card receipts and statements and two-
sided copies of cancelled checks, on-line bill pay transaction registers or other acceptable
evidence of payment, original tear sheets of print ads showing publication name and date,
affidavit of broadcast dates and times, screen shots of on-line ads showing date of capture, or
samples of printed materials to the Tourism Director, or his designee, for review and upon
verification by letter from the GRANTEE that the services or work performed as described in the
invoice have been completed or that the goods have been received and that all vendors have been
paid. Should these documents be unavailable, the GRANTEE may submit other legally viable
evidence of payment subject to review and approval by the Clerk's office.
(b) The Tourism Director, or his designee, shall determine that the invoice payments
are authorized and that the goods or services covered by such invoice [ s] have been provided or
performed in accordance with such authorization. The budget attached as Exhibit "F" shall
constitute authorization for the expenditure[s] described in the invoice[s].
( c) All expenditures shall be made in conformity with this Agreement.
(d) The COUNTY shall not pay GRANTEE until the Clerk of the Board of County
Commissioners pre-audits all payment invoices in accordance with law.
(e) GRANTEE shall be paid for its actual costs, not to exceed the maximum amount
budgeted pursuant to the attached "Exhibit F".
(f) Expenditures with publications, broadcast and brochure distribution with
circulation or reach outside Collier County over fifty percent (50%) of the total will be
acceptable for reimbursement at full value based on a statement from the publisher, broadcaster
or distributor attesting to that circulation percentage.
(g) Invoices for prepayment or for deposit on servIces will not be eligible for
reimbursement.
2
(h) Services or product must be delivered and paid for by GRANTEE between the
effective dates of this agreement.
(i) All requests for reimbursement must be received by September 30, 2012 to be
eligible for payment.
3. ELIGIBLE EXPENDITURES:
(a) Only eligible expenditures described in Paragraph One (1) will be paid by
COUNTY.
(b) COUNTY agrees to pay eligible expenditures incurred between October 1, 2011
and September 30, 2012.
(c) Any expenditures paid by COUNTY which are later deemed to be ineligible
expenditures shall be repaid to COUNTY within thirty (30) days of COUNTY's written request
to repay said funds.
(d) COUNTY may request repayment of funds for a period of up to three (3) years
after termination of this Agreement or any extension or renewal thereof.
4. INSURANCE:
(a) GRANTEE shall submit a Certificate of Insurance naming the Collier County
Board of County Commissioners and the Tourist Development Council as additional insureds.
(b) The certificate of insurance must be valid for the duration of this Agreement, and
be issued by a company licensed in the State of Florida, and provide General Liability Insurance
for no less than the following amounts:
BODIL Y INJURY LIABILITY $300,000 each claim per person
PROPERTY DAMAGE LIABILITY $300,000 each claim per person
PERSONAL INJURY LIABILITY $300,000 each claim per person
WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY - Statutory
(c) The Certificate of Insurance must be delivered to the Tourism Director or his
designee with copies of the Agreement executed by GRANTEE. The GRANTEE shall not
commence promotional or advertising activities which are to be funded pursuant to this
3
Agreement until the Certificate of Insurance has been received by the COUNTY and the
Agreement is fully executed.
5. REPORTING REQUIREMENTS:
(a) GRANTEE shall provide to County a preliminary status report on the form
attached hereto as Exhibit "A" within thirty (30) days of the effective date of the agreement.
(b) GRANTEE shall provide to County a calendar quarter interim status report on the
form attached hereto as Exhibit "B" whether or not a Request for Funds is submitted.
(c) GRANTEE shall provide to County a [mal status report on the form attached
hereto as Exhibit "C" no later than October 15,2012.
(d) Each report shall identify the economic impact generated by the GRANTEE
through the use of reports (Exhibits "A", "B" and "C") which identify the amount spent, the
duties performed, the services provided, and the goods delivered since the previous reporting
period.
(e) GRANTEE shall take reasonable measures to assure the continued satisfactory
performance of all vendors and subcontractors.
(f) COUNTY may withhold any interim or [mal payments for failure of GRANTEE
to provide the interim status report or [mal status report until the County receives the interim
status report or [mal status report or other report acceptable to the Tourism Director.
(g) GRANTEE shall request that visitors to the the Golisano Children's Museum of
Naples complete the visitor questionnaire attached to this Agreement as Exhibit "E". All
completed visitor questionnaires shall be maintained in accordance with Paragraph Thirteen (13)
of this Agreement.
6. CHOICE OF VENDORS AND FAIR DEALING:
(a) GRANTEE may select vendors or subcontractors to provide services as described
in Paragraph One (1).
(b) COUNTY shall not be responsible for paying vendors and shall not be involved in
the selection of subcontractors or vendors.
4
(c) GRANTEE agrees to disclose any fmancial or other relationship between
GRANTEE and any subcontractors or vendors, including, but not limited to, similar or related
employees, agents, officers, directors and/or shareholders.
(d) COUNTY may, in its discretion, object to the reasonableness of expenditures and
require payment if invoices have been paid under this Agreement for unreasonable expenditures.
The reasonableness of the expenditures shall be based on industry standards.
7. INDEMNIFICATION:
,
GRANTEE shall indemnify and hold harmless Collier County, its agents, 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 the GRANTEE or anyone employed or utilized
by the GRANTEE 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.
8. NOTICES:
All notices from the COUNTY to the GRANTEE shall be in writing and deemed duly
served if mailed by registered or certified mail to the GRANTEE at the following address:
Joe Cox, Executive Director
Golisano Children's Museum of Naples, Inc.
P.O. Box 2423
Naples, Florida 34106
All notices from the GRANTEE to the COUNTY shall be in writing and deemed duly
served if mailed by registered or certified mail to the COUNTY to:
Jack Wert, Tourism Director
Collier County Tourism Department
2800 N. Horseshoe Drive
Naples, Florida 34104
The GRANTEE and the COUNTY may change the above mailing address at any time
upon giving the other party written notification pursuant to this Section.
5
9. NO PARTNERSHIP: Nothing herein contained shall be construed as creating a
partnership between the COUNTY and the GRANTEp, or its vendors or subcontractors, or to
constitute the GRANTEE, or its vendors or subcontractors, as an agent or employee of the
COUNTY.
10. COOPERATION: GRANTEE shall fully cooperate with the COUNTY in all
matters pertaining to this Agreement and shall provide all information and documentation
requested by the COUNTY from time to time pertaining to the use of any funds provided
hereunder.
11. TERMINATION:
(a) The COUNTY or the GRANTEE may cancel this Agreement with or without cause
by giving thirty (30) days advance written notice of such termination specifying the effective date
of termination.
(b) If the COUNTY terminates this Agreement, the COUNTY will pay the
GRANTEE for all expenditures or contractual obligations incurred by GRANTEE, with
subcontractors and vendors, up to the effective date of the termination so long as such expenses are
eligible.
12. GENERAL ACCOUNTING: GRANTEE is required to maintain complete and
accurate accounting records. All revenue related to the Agreement must be recorded, and all
expenditures must be incurred within the term of this Agreement.
13. AVAILABILITY OF FUNDS: This agreement is subject to the availability of
Tourist Development Tax revenues. If for any reason tourist tax funds are not available to fund
all or part of this agreement, the COUNTY may upon written notice, at any time during the term
of this agreement, and at its sole discretion, reduce or eliminate funding under this agreement.
14. AVAILABILITY OF RECORDS: GRANTEE shall maintain records, books,
documents, papers and fmancial information pertaining to work performed under this Agreement
for a period of three (3) years. GRANTEE agrees that the COUNTY, or any of its duly authorized
representatives, shall, until the expiration of three (3) years after final payment under this
Agreement, have access to, and the right to examine and photocopy any pertinent books,
6
documents, papers, and records of GRANTEE involving any transactions related to this
Agreement.
15. PROHIBITION OF ASSIGNMENT: GRANTEE shall not assign, convey, or
transfer in whole or in part its interest in this Agreement without the prior written consent of the
COUNTY.
16. TERM: This Agreement shall become effective on October 1, 2011 and shall
remain effective for one year until September 30, 2012. If the project is not completed within the
term of this agreement, all unreleased funds shall be retained by the COUNTY. Any extension of
this agreement beyond the one (1) year term in order to complete the Project must be at the express
consent of the Collier County Board of County Commissioners.
17. The GRANTEE must request any extension of this term in writing at least sixty
(60) days prior to the expiration of this Agreement, and the COUNTY may agree by amendment to
this Agreement to extend the term for an additional 90 days.
18. EVALUATION OF TOURISM IMPACT: GRANTEE shall monitor and
evaluate the tourism impact of the Project, explaining how the tourism impact was evaluated,
providing a written report to the Tourism Director or his designee, along with a fmal budget
analysis by October 15,2012.
19. REQUIRED NOTATION: All promotional literature and all print, broadcast and
on-line media advertising must prominently list Collier County and the Tourist Development
Council as a source of funds to read "A cooperative effort funded by the Collier County Tourist
Development Tax" and/or display the CVB logo and web site address www.paradisecoast.com to
qualify for reimbursement.
20. AMENDMENTS: This Agreement may only be amended by mutual written
agreement of the parties, after review by the Collier County Tourist Development Council if
warranted.
7
IN WITNESS WHEREOF, the GRANTEE and COUNTY have respectively, by an authorized
person or agent, hereunder set their hands and seals on the date and year first above written.
r
Joe. ~
Printed/Typed Name
(2~ ~+
K~6.a.. ~~_
Printe Typed Name
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
By: '1uL W. ~
FRED W. COYLE, Chairm -
GRANTEE:
GOLISANO CHILDREN'S MUSEUM OF
NAPLES, INC.
BY:~
&-v4Lb J ~A-(;-j
Printed/Typed Name
ClAtvrLM.4- AJ
Printed/Typed Title
8
EXHIBIT "A"
Collier County Tourist Development Council
Preliminary Status Report
EVENT NAME:
REPORT DATE:
ORGANIZATION:
CONTACT PERSON:
TITLE:
ADDRESS:
PHONE:
FAX:
On an attached sheet, answer the followinQ Questions and attach it to your aoolication.
PRELIMINARY INFORMATION:
Is this a first time project? If not, please give details of past projects.
Do you anticipate using area hotels in support of your project?
If so, what are the estimated hotel room nights generated by project?
What is the estimated revenue generated by this project?
What is the estimated number of participants expected to visit the project?
If project planning is in progress, what has been done, what remains to be done, and are there any
problems?
If the project planning has not been started, why?
List any planned out-of-county advertising, marketing, and/or public relations that will be used in
support of the project.
9
EXHIBIT "B"
Collier County Tourist Development Council
Interim Status Report
EVENT NAME:
REPORT DATE:
ORGANIZATION:
CONTACT PERSON:
TITLE:
ADDRESS:
PHONE:
FAX:
On an attached sheet, answer the followinQ Questions to identify the status of the Dro;ect.
Submit this reDort at least Quarterlv.
INTERIM - These questions will identify the current status of the project. After the TDC staff
reviews this Interim Status Report, if they feel you are behind schedule on the planning stages,
they will make recommendations to help get the project stay on schedule.
Has the planning of this project started?
At what point are you at with the planning stage for this project? (Percent of completion)
Will any hotels/motels be utilized to support this project?
If so, how many hotel room nights will be utilized?
What is the total dollar amount to date of matching contributions?
What is the status of the advertising and promotion for this project?
Have your submitted any advertisements or printed pieces to the TDC staff for approval? Please
supply a sample and indicate the ad schedule.
How has the public interest for this project been up to this point?
10
EXHIBIT "("
Collier County Tourist Development Council
Final Status Report
EVENT NAME:
REPORT DATE:
ORGANIZATION:
CONTACT PERSON:
TITLE:
ADDRESS:
PHONE:
FAX:
-------------------------------------------------------------------
-------------------------------------------------------------------
On an attached sheet, answer the followina auestions for each element in your scooe of work.
Final- These questions should be answered for your final status report.
Was this a first time project? If not, how many times has this event taken place?
What hotels/motels were utilized to support the project and how many?
What is the total economic impact and revenue generated for this event?
Total expenses. (Have all vendors been paid?)
List the vendors that have been paid, if not, what invoices are still outstanding and why?
What is the number of participants that visited the project?
What is the percentage of the total participants from out of Collier County?
What problems occurred if any during the project event?
List any out-of-county- advertising, marketing, and/or public relations that was used to support the
project and attach samples.
How could the project been improved or expanded?
11
EXHIBIT flDII
REQUEST FOR FUNDS
COLLIER COUNTY TOURIST DEVELOPMENT COUNCIL
EVENT NAME
ORGANIZATION
ADDRESS
CONTACT PERSON
TELEPHONE (
REQUEST PERIOD
FROM
TO
REQUEST #
( ) INTERIM REPORT
( ) FINAL REPORT
TOTAL CONTRACT AMOUNT $
EXPENSE
BUDGET
REIMBURSEMENT REQUESTED
TOTALS
NOTE: Reimbursement of funds must stay within the confines of the Project Expenses outlined in your
application. Copies of paid invoices, cancelled checks, tear sheets, printed samples or other backup information
to substantiate payment must accompany request for funds. The following will not be accepted for payments:
statements in place of invoices; checks or invoices not dated; tear sheets without date, company or
organizations name. A tear sheet is required for each ad for each day or month of publication. A proof of an ad
will not be accepted.
For each request for payment, Grantee is required to submit verification in writing that all subcontractors and
vendors have been paid for work and materials previously performed or received prior to receipt of any further
payments.
If project budget has specific categories with set dollar limits, the Grantee is required to include a spreadsheet
to show which category each invoice is being paid from and total of category before payment can be made to
Grantee. Organizations receiving funding should take into consideration that it will take a maximum of 4S days
for the County to process a check.
Furnishing false information may constitute a violation of applicable State and Federal laws.
CERTIFICATION OF FINANCIAL OFFICER: I certify that the above information is correct based on our official
accounting system and records, consistently applied and maintained and that the cost shown have been made
for the purpose of and in accordance with, the terms of the contract. The funds requested are for
reimbursement of actual cost made during this time period.
SIGNATURE
TITLE
12
EXHIBIT"E"
Naples @
Marco Island
~
Everglades
PARADISE COAST"
VISITOR QUESTIONNAIRE
Welcome to the Paradise Coast SM, Thank you for choosing this area for your visit. Please take
a few minutes to complete the following questions so that we can better serve the needs of
future visitors to Florida's Last Paradise SM. PLEASE REFER TO OUR PARADISE COAST BROCHURES FOR
THE LOCATION OF ALL AREA ATTRACTIONS.
NAME:
ADDRESS:
DATE OF ARRIVAL:
WHERE ARE YOU
STAYING?
NAME OF HOTEL AND CITY/AREA:
NAME OF CONDOMINIUM/TIMESHARE:
# OF ROOMS OCCUPIED x NUMBER OF NIGHTS STAYING IN COLLIER COUNTY =
HOW DID YOU SELECT THE HOTEL/CONDOMINIUM?
INTERNET ( ) YOUR CHOICE ( )
OTHER:
NUMBER OF MEALS YOU & YOUR GROUP WILL EAT OUT:
Number of people in your party = _
Number of days of your visit =
Number of meals eaten out each day =
PLANNED AREA ACTIVITIES: (Please circle all that apply)
ARTS & CULTURE WATER SPORTS NATURE
von Liebig Art Center Beaches Everglades Tour
Naples Museum of Art Naples Pier County Parks
Sugden Theatre Shelling National Park
Naples Philharmonic Fishing State Parks
Art Galleries Boating Corkscrew Swamp
Kayaking Conservancy of SW FL
Lake Trafford
Other
HOTEL/RESORT
CITY
DATE OF DEPARTURE:
FRIENDS/FAMILY
ST
ZIP
CONDOMINIUM
TRAVEL AGENT (
Other
FAMILY ATTRACTIONS
Naples Zoo
Naples Botanical Garden
Fun 'n Sun Water Park
Swamp Buggy Race
Mini Golf
King Richard's Fun Park
County Museums
Other
Other
SHOPPING AND DINING
Fifth Avenue South
Third Street South
Waterside Shops
Venetian Bay
Bayfront
Tin City
Prime Outlets
SIGHTSEEING
Lunch/Dinner Cruisel
Sunset Cruise
City Trolley Tour
Everglades Tour
Segway Tour
Dolphin Cruise
Other
RELAXATION &
ENTERTAINMENT
Golf
Spa
Shelling
Seminole Casino
Lounges & Clubs
Music
Other
Other
13
EXHIBIT "F"
Golisano Children's Museum of Naples, Inc.
Project Budget
Fundina - Not to Exceed
Out of County Advertising and Marketing Expenses to include:
Broadcast Campaign
Print Advertising
Radio Advertising
Collateral Materials
Total:
$100,000
14
~
ACORD. CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDNYVY)
~ 9/22/2011
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 ~~~~~CT Kristi Tulin
Lutgert Insurance - Naples rA~gNJo Exl\: ? -, q -? h? - 71 71 I rfi~, No': ., -, D. ? h? - C; -, h n
PO Box 112500
Naples FL 34108 ~~DA~~SS: ktulin@lutaertinsurance.com
PRODUCER
CUSTOMER 10 #:
INSURER(S) AFFORDING COVERAGE NAIC #
INSURED INSURER A : Southern-Owners 10190
Children's Museum of Naples INSURER B :
PO Box 2423
Naples FL 34106 INSURER C :
INSURER D :
INSURER E :
INSURER F :
COVERAGES
CERTIFICATE NUMBER: 988504576
REVISION NUMBER: 1
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 ADOL SUBR 1,~~}-J%Mlfv, POLICY EXP
LTR TYPE OF INSURANCE IINSR WVD POLICY NUMBER MMIDONYVY LIMITS
A GENERAL LIABILITY 2071418810 11/1/2010 11/1/2011 EACH OCCURRENCE $1,000,000
- ~~~~~U?E~~~~~~nce\
X :3MMERCIAL GENERAL LIABILITY POO,OOO
- CLAIMS-MADE G:J OCCUR
- MED EXP (Anyone person) $10,000
- PERSONAL & ADV INJURY $1,000,000
- GENERAL AGGREGATE $2,000,000
~'L AGGREnE LIMIT APnS PER. PRODUCTS - COM PlOP AGG $2,000,000
POLICY ~fP;: LOC $
A AUTOMOBILE LIABILITY 2071418810 11/1/2010 11/1/2011 COMBINED SINGLE LIMIT $1,000,000
- (Ea accident)
- ANY AUTO BODILY INJURY (Per person) $
- ALL OWNED AUTOS BODILY INJURY (Per accident) $
- SCHEOULED AUTOS PROPERTY DAMAGE
$
X HIRED AUTOS (Per accident)
-
X NON-OWNED AUTOS $
-
$
UMBRELLA L1AB H OCCUR EACH OCCURRENCE $
-
EXCESS L1AB CLAIMS-MADE AGGREGATE $
DEDUCTIBLE $
-
RETENTION $ $
WORKERS COMPENSATION I T"6~~ItJI~S I IOTH-
AND EMPLOYERS' LIABILITY ER
Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE D N/A E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $
If yes, describe under EL. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCA TIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
office non-profit
Re: Contract #11-5734
CERTIFICA TE HOLDER
CANCELLA TION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED
IN ACCORDANCE WITH THE POLICY PROVISIONS.
Collier County Board of Commissioners
3301 East Tamiaim Trail
Naples FL 34112 AUTHORIZED REPRESENTATIVE
I ?la~
ACORD 25 (2009/09)
@1988-2009ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
I DATE (MM/DD/YY)
ACORDrM CERTIFICA TE OF LIABILITY INSURANCE 10/05/2011
PRODUCER 1-877-266-6850 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Paychex Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
150 Sawgrass Dr AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Rochester, NY 14620 INSURERS AFFORDING COVERAGE
INSURED INSURER A: ILLINOIS NATIONAL INSURANCE COMPANY
Paychex Business Solutions, Inc. INSURER B:
Go1isano Chi1drens Museum of Naples Inc
INSURER C:
911 Panorama Trail South INSURER D:
Rochester, NY 14625
877-266-6850 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,
iNSR POLICY EFFECTIVE POLICY EXPIRATION
LTR TYPE OF INSURANCE POLICY NUMBER DATE (MMIDD/YY) DATE (MMIDDIYY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
-
COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Ally one fire) $
- :=J CLAJMS MADE D OCCUR
MED EXP (Anyone person) $
-
PERSONAL & ADV INJURY $
-
GENERAL AGGREGATE $
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $
I nPRO-n
POLICY JECT LOC
~OMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO (Ea accident) $
-
ALL OWNED AUTOS BODILY INJURY
- (Per person) $
SCHEDULED AUTOS
-
HIRED AUTOS BODILY INJURY
i-- (Per accident) $
NON-OWNED AUTOS
i--
- PROPERTY DAMAGE
(Per accident) $
~RAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO EAACC $
OTHER THAN AUTO
ONLY: AGG $
3ESS LIABILITY EACH OCCURRENCE $
OCCUR D CLAJMS MADE I AGGREGATE $
$
~ DEDUCTIBLE I $
RETENTION $ $
A WORKERS COMPENSATION AND EMPLOYERS' WC 011 598 305 06/01/11 06/01/12 X I WCSTATU- I 10:-
LIABILITY TORY LIMITS
E.L. EACH ACCIDENT $ 1,000,000
E.L. DISEASE - EA EMPLOYEE $ 1,000,000
E.L. DISEASE - POLICY LIMIT $ 1,000,000
OTHER
$
$
$
DESCRIPTION OF OPERATIONSlLOCATlONSlVEHICLESlEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
WORKERS COMPENSATION COVERAGE IS PROVIDED TO ONLY THOSE EMPLOYEES LEASED TO, BUT NOT SUBCONTRACTORS OF THE NAMED INSUR
CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE
Collier County Board of County Commissioners THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ...2Q... DAYS WRITTEN NOTICE TO THE
CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION
3327 Tamiami Trail N OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
Naples, FL 34112 AUTHORIZED REPRESENTATIVE ~~
USA
D
ACORD 25-S (7197)
CJAMES
23504511
@ACORD CORPORATION 1988