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Backup Documents 11/13/2012 Item #16E 2ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 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. 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 ..c.we t- u—....e..I ....oh.— dry— lion th--h —Aina line d! 1 thrnuah fit cmmnlete the checklist and forward to the Countv Anomev Office. Route to Addressees (List in routing order ) Office Initials Date 1. appropriate. Initial Applicable) 2. November 13, 2012 Agenda Item Number 16.E.2 3. Scott r. Teach, Deputy County Attorney County Attorney Office S Is =44W 40— 4. BCC Office Board of County Commissioners Number of Original 1 5. Minutes and Records Clerk of Court's Officem Documents Attached PRIMARY CONTACT 1NFOKMA'r1U1N 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 ,r-- -AA:..' al information above, may need to contact staff Name of Primary Staff ltlon or missm Diana Deleon, Purchasing Dept. Phone Number 252 -8375 Contact / Department appropriate. Initial Applicable) Agenda Date Item was November 13, 2012 Agenda Item Number 16.E.2 Approved by the BCC Does the document need to be sent to another agency for additional signatures? If yes, DA Type of Document Contract/Agreement Number of Original 1 Attached #12 -5983 Agreement to Perform Autopsies Documents Attached signed by the Chairman, with the exception of most letters, must be reviewed and signedA PO number or account by the Office of the County Attorney. number if document is All handwritten strike - through and revisions have been initialed by the County Attorney's i to be recorded Office and all other parties except the BCC Chairman and the Clerk to the Board INSTRUCTIONS & CHECKLIST Rl_EA►s ru �c� s � I Lxfcu -rcD l! o`t/ 15 �T � �'o� BE�,� -t� �l-•t p.c�St � trtrvs 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? 12V R 2. Does the document need to be sent to another agency for additional signatures? If yes, DA provide the Contact Information (Name; A enc ; 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 signedA by the Office of the County Attorney. 4. All handwritten strike - through and revisions have been initialed by the County Attorney's i 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 document or the final negotiated contract date whichever is applicable. 6. "Sign here" tabs are placed on the appropriate pages indicating where the Chairman 's signature and initials are required. 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. Some documents are time sensitive and require forwarding to Tallahassee within a certain T time frame or the BCC's actions are nullified. Bea are ofaour deadlines! 8. The document was approved by the BCC on and all changes made —n during the meeting have been incorporated in the attached document. The County Attorney's Office has reviewed the chap es, if applicable. a 9. Initials of attorney verifying that the attached document is the version approved by the BCC, all changes directed by the BCC have been made, and the document is ready for the s Chairman's signature, Rl_EA►s ru �c� s � I Lxfcu -rcD l! o`t/ 15 �T � �'o� BE�,� -t� �l-•t p.c�St � trtrvs 14E 21 MEMORANDUM Date: January 18, 2013 To: Diana De Leon, Contract Technician Purchasing Department From: Martha Vergara, Deputy Clerk Minutes & Records Department Re: Contract #12 -5983 "Agreement for Autopsies" Contractor: Physicians Regional Attached, is an original copy of the contract referenced above (Item #16E2), approved by the Board of County Commissioners on Tuesday, November 13, 2012. The original will be held on file with the Minutes and Record's Department in the Board's Official Records. A scanned copy has been sent to you as well as to Joe Bernard at Physicians Regional. If you have any questions, please contact me at 252 -7240. Thank you. Attachment 16 2'4 Purchasing Department • +C: c1t 3327 Tamiami Trail East Naples, Florida 34112 Sew Division Telephone: (239) 252 -8375 Purchasing FAX: (239) 252 -6597 JAN 1 (; L��� Email: dianadeleon cDcolliergov.net www.colliergov.negpurchasing Memorandum RISK M!`r; Subject: 12 -5983 "Agreement to Perform Autopsies" Date: January 9, 2013 From: Diana DeLeon, CPPB, Contract Technician, Purchasing Dept. To: Jeff Walker, Director Risk Management This Contract was approved by the BCC on November 13, 2012 agenda item 16.E.2. The County is in the process of executing this contract with HMA dib /a Physicians Regional Healthcare System. The contract cannot take place until verification is received from Risk that all the insurance requirements, per the contract, have been met. 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. Insurance Approved By: pt agement Signature Date (Please route to County Attorney via attached Request for Legal Services) G /Acquisitions /AgentFormsand Letters /RiskMgmtReviewofl nsurance4 /15/2010/16/09 16E 21 DeLeonDiana From: Bernard, Joe Doe.bernard @hma.com] Sent: Tuesday, January 08, 2013 4:56 PM To: TeachScott Cc: Lowe, Scott; Kishbaugh, Troy; Mancini, Tracey; DeLeonDiana Subject: RE: Contract 12 -5983 Agreement to Perform Autopsies; Physicians Regional & Collier County Hmmm ... even better. Diana has the signed agreements and will be able to send them your way. Thank you, Scott. Joe Bernard, COO Physicians Regional Healthcare System 239 - 304 -4876 From: TeachScott [ mailto :ScottTeach(a)colliergov.net] Sent: Tuesday, January 08, 2013 4:54 PM To: Bernard, Joe Cc: Kishbaugh, Troy; Mancini, Tracey; DeLeonDiana Subject: RE: Contract 12 -5983 Agreement to Perform Autopsies; Physicians Regional & Collier County Joe, This is the first time this issue has come to my attention. I have no objection to accepting the contract signed by HMA's CFO. Please forward to my attention and I will sign and present to the Board's Chairman for execution. Scott R. Teach Deputy County Attorney Collier County, Florida Tel: (239) 252 -8400 Fax: (239) 252 -6300 Office of the County Attorney, 3299 East Tamiami Trail, Suite 800, Naples, FL 34112 Under Florida Law, e -mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by telephone or in writing. From: Bernard, Joe [mailto:joe.bernard @hma.com] Sent: Tuesday, January 08, 2013 4:46 PM To: TeachScott Cc: DeLeonDiana; Kishbaugh, Troy; Mancini, Tracey Subject: Contract 12 -5983 Agreement to Perform Autopsies; Physicians Regional & Collier County Scott, I have discussed this matter with one of our Health Management attorneys, Troy Kishbaugh (his assistant Tracey can be reached at 239.552.3764). It may be best if you contact Troy so the two of you can agree on the most effective way to wrap up this particular matter. I do appreciate the support of all to close the loop on this issue. Thank you, Joe Bernard, COO Physicians Regional Healthcare System 239 - 304 -4876 16E 21 From: DeLeonDiana fmailto : Diana DeLeon('Ocolliergov.net] Sent: Tuesday, January 08, 2013 4:29 PM To: Bernard, Joe Cc: TeachScott Subject: Contract 12 -5983 Agreement to Perform Autopsies; Physicians Regional & Collier County Joe, In response to your call, I'm copying Scott Teach, Deputy County Attorney, on this e-mail in order to get this issue settled and get the contract reviewed and signed. Please contact Scott directly. Thanks, F s From: DeLeonDiana Sent: Tuesday, January 08, 2013 8:47 AM To: 'Bernard, Joe' Cc: Mancini, Tracey Subject: RE: Agreement to Perform Autopsies; Physicians Regional & Collier County Joe, Attached are the sunbiz.org pages that our County Attorney's office look at when they review the contract and the contract's signatory. They use it to verify that the person that signs is listed as a principal on sunbiz. However, since there are no principals listed, they will require the corporate resolution. Therefore, even if Mr. Lupton signs the contracts, they will still ask for the resolution. Please let me know if you have any questions. Thanks, Diana Diaz DeLeon, CPPB Collier County BCC Purchasing Dept. 3327 E. Tamiami Trail Naples, FL 34112 (239)252- 8375;(239)252 -6597 Fax From: Bernard, Joe fmailto:joe.bernard @ hma.com] Sent: Tuesday, January 08, 2013 7:31 AM To: Mancini, Tracey Cc: DeLeonDiana Subject: Agreement to Perform Autopsies; Physicians Regional & Collier County Importance: High Tracey, We are trying to finalize an agreement with Collier County. Scott Lowe, CFO, signed the agreement, but the County is requesting the following -- a corporate resolution with the corporate seal giving Scott Lowe authority to bind the hospital. Can you assist with this request. If not, my next step is to get the agreement back from Collier County and have it signed by Todd Lupton, CEO ... I imagine his signature will be "accepted." Thank you, Joe Bernard, COO Physicians Regional Healthcare System 239 - 304 -4876 16E 2­1 Under Florida Law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by telephone or in writing. 16E 24 AGREEMENT #12 -5983 BETWEEN COLLIER COUNTY, FLORIDA AND NAPLES HMA, LLC DB /A PHYSICIANS REGIONAL HEALTHCARE SYSTEM RELATING TO A LICENSE AGREEMENT TO PERFORM AUTOPSIES This Agreement is made by and between Collier County, Florida, a political subdivision of Florida hereafter referred to as "County" and Naples HMA, LLC d/b /a Physicians Regional Healthcare System, hereafter referred to as "Hospital ", on this day of 2012. 1. This Agreement relates to the use of the Collier County Medical Examiner Facility ( "Medical Examiner ") located at 3838 Domestic Avenue Naples, Florida, hereafter referred to as "the Facility" by Hospital for the sole purpose of conducting non - Medical Examiner autopsies. The County hereby grants to Hospital a license to use the Facility to conduct autopsies. "Hospital" shall mean all physicians with privileges at the Physicians Regional Healthcare System locations at 8300 Collier Boulevard and 6101 Pine Ridge Road in Naples, Florida. 2. This Agreement is entered into on the above date and shall continue until terminated. Either parry may terminate this Agreement without cause by conveying to the other parry a "Notice to Vacate" the Facility, whereupon the Facility shall be fully vacated within no more than thirty (30) days following receipt of such notice. 3. All notices, demands, or other writings required to be given, made or sent by either party to the other shall be addressed to the following: FOR Hospital Joe Bernard, Chief Operating Officer Physicians Regional Healthcare System 8300 Collier Boulevard Naples, FL 34114 and FOR County Joanne Markiewicz Interim Purchasing /General Services Director Collier County Purchasing Department 3327 East Tamiami Trail Naples, Florida 34112 1 16E 2 4. Hospital agrees to: a. Perform all autopsies by qualified staff pathologists of the Hospital. b. Cooperate with the policies and procedures of the Medical Examiner's Office and adhere to proper standards of practice in performance of autopsies. Hospital understands that the Medical Examiner's workload is of primary importance, although every effort will be made to accommodate, in a timely manner, the needs of the Hospital. C. Comply with all local, state and federal laws and regulations at all times. 5. County agrees to: a. Provide the utilization of the services of the District Twenty Medical Examiner technical staff and all necessary supplies required for the performance of autopsies and to maintain all working areas in a safe and clean condition. b. Make available the Facility and personnel during regular, weekend, or holiday hours, whenever possible to Hospital. 6. Hospital shall pay to the County a User's Fee of Three Hundred Fifty Dollars ($350.00) for each autopsy performed by or for Hospital at the Facility and Two Hundred Dollars ($200.00) for each autopsy that is limited to the cranial contents only. The fees will be used to pay for all costs and expenses for supplies and labor of the Medical Examiner operations used in performance of said autopsies and does not include any physician associated fees. The County shall furnish a bill to Hospital each month for all autopsies performed during the preceding month, which shall be due and payable not more than thirty (30) days following receipt of such bill. 7. Hospital is the sole judge of the suitability of the Facility and the County makes no representations that the Facility is suitable for any need of Hospital. Hospital takes the Facility "as is" and the County has no obligation to modify the Facility. 8. Hospital shall indemnify, defend and hold harmless County and the District Twenty Medical Examiner, Inc. against any actions, claims, liabilities, injuries, suits, demands, expenses or damages arising out of the Hospital's negligent acts or omissions in connection with the performance of this Agreement. In the event that a claim is made against one or more parties, it is the intent of such parties to cooperate in the defense of said claim. However, such parties shall have the right to take any and all actions they believe necessary to protect their interests. 9. The Hospital shall provide insurance as follows: A. Commercial General Liability: Coverage shall have minimum limits of $1,000,000 Per Occurrence, Combined Single Limit for Bodily Injury Liability and Property Damage Liability. This shall include Premises and 2 16E 24 Operations; Independent Contractors; Products and Completed Operations and Contractual Liability. C. Workers' Compensation: Insurance covering all employees meeting Statutory Limits in compliance with the applicable state and federal laws. The coverage must include Employers' Liability with a minimum limit of $500,000 for each accident. Special Requirements: Collier County Government shall be listed as the Certificate Holder and included as an Additional Insured on the Comprehensive General Liability Policy. Current, valid insurance policies meeting the requirement herein identified shall be maintained by Hospital during the duration of this Agreement. Renewal certificates shall be sent to the County ten (10) days prior to any expiration date. There shall be a minimum of ten (10) day notification to the County in the event of cancellation or modification of any stipulated insurance coverage. Hospital shall also notify County, in a like manner, within twenty -four (24) hours after receipt, of any notices of expiration, cancellation, non - renewal or material change in coverage or limits received by Hospital from its insurer, and nothing contained herein shall relieve Hospital of this requirement to provide notice. Hospital shall ensure that all subContractors comply with the same insurance requirements that it is required to meet. 10. This agreement is a non - exclusive agreement. Hospital agrees that the County shall have the right to enter into agreements with other parties to allow the use of the Facility for similar programs. 11. Compliance with Laws. By entering into this agreement, the parties specifically intend to comply with all applicable laws, rules and regulations as they may be amended from time to time. In the event that any part of this agreement is determined to violate federal, state or local laws, rules, or regulations, the parties agree to negotiate in good faith revisions to the provision or provisions that are in violation. In the event the parties are unable to agree to new or modified terms as required to bring the entire agreement into compliance, either party may terminate this agreement on thirty (30) days written notice to the other parry. 12. Compliance with Federal Programs. County hereby represents and warrants that it has not been debarred, suspended, excluded or otherwise determined to be ineligible to participate in Federal healthcare programs (collectively, "Debarred ") and agrees not to engage or assign any employee, agent or contractor ( "Agent ") to perform services under this Agreement who has been Debarred. County acknowledges that Hospital shall have the right to 3 r terminate this agreement immediately in the event that County or an Agent is Debarred, Accordingly, County shall provide Hospital with immediate notice if during the term of this Agreement County (i) receives notice of action or threat of action with respect to its Debarment; or (ii) becomes Debarred. 13. Confidentiality. County acknowledges that, in the course of performing its obligations under this Agreement, County's employees, agents, independent contractors or other representatives (hereinafter "Representatives ") may learn certain confidential information about Hospital's business and/or patient care operations (the "Confidential Information "). County agrees that it and its Representatives will keep the Confidential Information strictly confidential, and that they will not use it for any other purpose other than to perform their obligations hereunder, and that they will not resell, transfer or otherwise disclose the Confidential Information to any third party without Hospital's specific, prior written consent. Upon termination of this agreement, if so requested by Hospital, County shall return to Hospital or destroy any Confidential Information (and all copies thereof). Confidentiality is subject to Chapter 119, Florida Statutes, also known as the Public Records Law. 14. Use of Name. County shall not use the name, logo, likeness, trademarks, image or other intellectual property of Hospital for any advertising, marketing, endorsement or any other purposes without the specific prior written consent of an authorized representative of Hospital as to each such use. 15. Amendment. This Agreement may not be amended, modified or changed orally. Any amendments, modifications and changes must be in writing and - executed by an authorized representative of each of the parties hereto. 16. Independent Contractor. In the performance of County's obligations under this Agreement, County shall at all times act as and be deemed an independent contractor. Nothing in this Agreement shall be construed to render County or any of its employees, agents or offices, an employee, joint venturer, agent or partner of Hospital. County is not authorized to assume or create any obligations or responsibilities; express or implied, on behalf of or in the name of Hospital, except as specifically herein. The employees, methods, facilities, and equipment of County shall at all times be under County's exclusive direction and control. 17. Assignment. Neither party may assign this Agreement nor any rights or obligations under this Agreement without the prior written consent of the other party and any such assignment not in accordance herewith shall be null and void ab initio. 18. Entire Agreement. This- Agreement, together with all exhibits attached hereto, constitutes the entire agreement between the parties hereto pertaining to the 4 16E 24 subject matter hereof, and any and all other written or oral agreements existing between the parties hereto are expressly canceled. 19. Governing Law. This Agreement shall be construed in accordance with the laws of the State of Florida without regard to its conflict of laws provisions. 20. Conflict. Hospital maintains and adheres to a Conflict of Interest Policy. In that connection, County represents that no Hospital employees, officers or directors are employees, officers or directors of County or serve on any boards or committees of or in any advisory capacity with County. ATTF$4 BOARD OF COUNTY COMMISSION DVHT E. BOG, Clerk COLLIER COUNTY, FLORIDA By, Approved as to form and sufficie y �Y Zeputy County Attorney S c�ft R -Tc . I— Print Name Fred W. Coy PHYSICIANS REGIONAL HEALTHCARE SYSTEM By: First Witness Signature SHWA/ M - GkeC4AJY �TfType /printt witness nameT / Second Witness /7::�� p H �j FR �Yrt !c!J �J1c TType /print witness nameT Su -tt - Lo ,c LT—J Typed signature and title 16E 24 CERTIFICATE OF LIABILITY INSURANCE November 29, 2 IRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY COVERAGE IS INDEPENDENTLY PROCURED BY THE INSURED. AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING INSURERS AFFORDING COVERAGE NAIC # INSURED Health Management Associates, Inc. 5811 Pelican Bay Blvd, Suite 500 Naples, Florida 34108 INSURER A: Insurance Company of the Southeast, Ltd. ADD'Ll INSURERS: as insurance manager and authorized representative INSURER C: POLICY EXPIRATION INSURER D: LTR INSURER E: TYPE OF INSURANCE Cr)VFRAr:FS DATE MMIDD DATE MWDD 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 ADD'Ll as insurance manager and authorized representative POLICY EFFECTIVE POLICY EXPIRATION LTR INSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDD DATE MWDD LIMITS A ❑ GENERAL LIABILITY ® COMMERICAL GENERAL LIABILITY ❑❑ CLAIMS MADE ® OCCUR ❑ ICSE PR1011213 10/01/12 10/01/13 EACH OCCURRENCE $1,000,000 FIRE DAMAGE (ANY ONE FIRE $1,000,000 MED EXP (Any one person) $N /A PERSONAL & ADV INJURY $1,000,000 ❑ GENERAL AGGREGATE $UNLIMITED GEN'L AGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑ PROJECT ❑ LOC PRODUCTS - COMP /OP AGG $UNLIMITED ❑ AUTOMOBILE LIABILITY ❑ ANY AUTO COMBINED SINGLE. LIMIT (Each Occurrence) $ ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS BODILY INJURY (Per person) $ ❑ HIRED AUTOS F-1 NON-OWNED AUTOS BODILY INJURY (Per accident) $ ❑ 11 _ PROPERTY DAMAGE (Per accident) $ ❑ GARAGE LIABILITY ❑ ANY AUTO ❑ AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: EA ACC $ AGG $ El EXCESS I UMBRELLA LIABILITY []OCCUR ❑ CLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DEDUCTIBLE ❑ RETENTION $_ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ❑ W STATU- TORC Y LIMITS ❑ OTH- ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under SPECIAL PROVISIONS below EL. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT ! SPECIAL PROVISIONS Evidence of coverage for Physicians Regional Medical Center, 6101 Pine Ridge Road, Naples, FL Certificate Holder is included as Additional Insured where required by written contract. CERTIFICATE HOLDER CANCELLATION Collier County Board of County Commissioners 3327 Tamiaml Trail East Naples, FL 34112 -4901 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISISONS AUTHORIZED REPRESENTATIVE as insurance manager and authorized representative A °® CERTIFICATE OF LIABILITY INSURANCE DATE 12104/12012 2012 IYYYY) 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 Marsh USA, Inc. 1801 West End Avenue, Suite 1500 Nashville, TN 37203 CONTACT NAME: PHONE FAX A/C No l: E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # - INSURER A : Liberty Insurance Corporation 42404 072392 - ALL- AUWC -12 -13 INSURED Health Management Associates, Inc. INSURER B : N/A N/A INSURER C: 5811 Pelican Bay Boulevard, Suite 500 Naples, FL 34108 -2710 INSURER D: INSURER E., $ - INSURER F : 1 --�J $ COVERAGES CERTIFICATE NUMBER: ATL- 003131150 -01 REVISION NUMBER' 2 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 LTR I TYPE OF INSURANCE ADDL SUER - POLICY NUMBER MM/DDY/YYYY MWDDfYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1 OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ POLICY PRO - T LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea aoold.nt $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per f ) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? N NIA WA7- 65D- 004245 -012 10/0112012 10/01/2013 X I WC STATU- .70TH- TORY LIMITS i FIR E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below I E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101 -, Additional Remarks Schedule, if more space is required) Evidence of coverage for Physicians Regional Medical Center, 6101 Pine Ridge Road, Naples, FL Collier County Board of County Commissioners 3327 Tamiami Trail East Naples, FL 341124901 I IVIN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Marjorie L. Rippy -m_40.,a A. A'�� ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD