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Backup Documents 01/08/2019 Item #16E1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO \ ' ./e , !,1 THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR = t'(i ! 1-" Print on pink paper. Attach to original document. The completed routing slip and original documents are to be s. heCon+. „i rney Office at the time the item is placed on the agenda. All completed routing slips and original documents must be r e es in thecoei rney Office no later than Monday preceding the Board meeting. aP **NEW** ROUTING SLIP eme�t Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is alrea �te with the exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to theity Attorney Office. Route to Addressee(s) (List in routing order) Office Initials Daae 1. Risk Risk Management til. eV/9 2. County Attorney Office County Attorney Office t�%C 4. BCC Office Board of County iC' Commissioners y-- ��,'v/ ZV \C\ 4. Minutes and Records Clerk of Court's Office KWh -2P-51 11 (1,51 5. Procurement Services Procurement Services 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 additi al or missing information. Name of Primary Staff Ana Reynoso/PURL SING Contact Information 239-252-8950 Contact/ Department Agenda Date Item was January 8, 2019 Agenda Item Number 16.E.1 Approved by the BCC Type of Document CONTRACT Number of Original 2 Attached Documents Attached PO number or account N/A 19-001 WV Cooperative number if document is Cooperative Services of Florida, to be recorded Services of Florida, Inc. Inc. INSTRUCTIONS & CHECKLIST Initial the Yes column or mark"N/A"in the Not Applicable ,whic -ver is Yes N/A(Not appropriate. (Initial) Applicable) 1. Does the document require the chairman's original signature TAMP OK N/A 2. Does the document need to be sent to another agency for addition. ignatur= ? If yes, N/A provide the Contact Information(Name;Agency;Address;Phone)on . . ached 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 final 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 01/08/2019 and all changes made during the meeting have been incorporated in the attached document. The County Attorney's Office has reviewed the changes,if applicable. 9. Initials of attorney verifying that the attached document is the version approved by the itla R4E- BCC,all changes directed by the BCC have been made, and the document is ready f' the Chairman's signature. ' .4 1 6 E 1 MEMORANDUM Date: February 25, 2019 To: Ana Reynoso, Procurement Services From: Martha Vergara, Sr. Deputy Clerk Minutes & Records Department Re: Contract #18-0001 WV "Participation Agreement" Contractor: Cooperative Services of Florida, Inc. Attached for your records is an original of the referenced document above, (Item #16E1) adopted by the Board of County Commissioners on Tuesday, January 08, 2019. The Board's Minutes & Records Department has kept an original as part of the Board's Official Records. If you have any questions, please feel free to contact me at 252-8411. Thank you. Attachment 16E 1 PARTICIPATION AGREEMENT Vth THIS PARTICIPATION AGREEMENT (this "Agreement") is made effective as of the day of 201nthe"Effective Date"), by and between Cooperative Services of Florida, Inc., a Florida corporation not for profit ("CSF" or "Contractor"), and Collier County Board of County Commissioners, do Emergency Medical Services ("Purchaser"or"County"). ARTICLE 1: RECITALS 1.1 CSF was created to develop and operate a health care purchasing cooperative in order to obtain price savings through the use of the combined purchasing power of its non-member participants (the "Participants")and its members (the"Members"). 1.2 Purchaser desires to become a Participant of CSF and utilize the services of CSF, and CSF desires for Purchaser to become a Participant and utilize such services provided Purchaser complies with the requirements of this Agreement. NOW, THEREFORE, in consideration of the foregoing and of the mutual covenants and obligations herein contained, the parties have agreed as follows: ARTICLE 2: INCORPORATION OF RECITALS, EXHIBITS, ETC. The parties agree that the recitals are true and correct and are hereby incorporated. The parties also agree that any referenced exhibits, schedules, documents, or instruments are hereby incorporated. ARTICLE 3: PARTICIPATION PROVISIONS 3.1 Participation Fee. Upon execution of this Agreement, Purchaser shall pay to CSF a Participation fee of $0.00 (the "Participation Fee"). The Participation Fee is non-refundable and may be different from the participation fees charged to other Participants. There are no annual or other periodic fees or dues payable by Participants. 3.2 Acceptance. CSF hereby accepts Purchaser as a Participant and Purchaser hereby accepts such position. Such participation is non-exclusive, and CSF may have other Participants and Members in Purchaser's service area. 3.3 Other Agreements. Each Participant of CSF is required to execute a Participation Agreement. However, except as required by law, CSF may exempt other Participants from any provision of this Agreement in its sole and absolute discretion. CSF is not required to deal with other Participants based upon the terms or conditions set forth herein. CSF shall not be responsible or liable for any loss or damage suffered by Purchaser which arises or results from the failure of any Participant to comply with the terms of its agreement with CSF. ARTICLE 4: TERM AND TERMINATION 4.1 Term. Unless earlier terminated, this Agreement shall be for a term of one (1) year(s), beginning on the Effective Date. This Agreement may renew for three (3) additional one (1) year period terms upon written approval of CSF and Purchaser unless either party provides written notice to the other party of its intention to terminate at least 30 days prior to the expiration of the then current term. 4.2 Termination by Notice. Each party may terminate this Agreement without cause by giving not less than thirty(30) calendar days written notice to the other party of intention to terminate. 4.3 Termination upon Breach. If either party gives written notice to the other party that such other party has substantially and materially breached the terms of this Agreement, and such breach shall not have been cured within 30 calendar days of the date of such notice, the party giving notice of the breach will 16E 1 have the right to terminate this Agreement at any time thereafter upon written notice of such termination to the other party. ARTICLE 5: PURCHASING PROVISIONS 5.1 Purchasing. Purchaser hereby designates CSF as its purchasing agent for the "Specified Product Categories" listed in Exhibit A and CSF agrees to use its best efforts to negotiate preferential terms of purchase for goods and services which are or might be used by its Participants or Members. Purchaser may make recommendations to CSF for products and services to be available for purchase and the names of vendors with whom it would like CSF to establish relationships. CSF will inform Purchaser of the availability of products and services for purchase from time to time. The terms negotiated by CSF will be available to Purchaser only through compliance with this Agreement. Such terms may include the requirement that vendors verify Purchasers' purchase orders with CSF prior to acceptance. Payments will be made directly to LeeSar, Inc. as CSF's primary distributor of products purchased under this Agreement and pursuant to Chapter 218, Fla. Stat., otherwise known as the "Local Government Prompt Payment Act." 5.2 Purchasing Commitment. (a) Purchaser acknowledges and agrees that, in order for CSF to be able to negotiate favorable cooperative purchasing agreements, Participant must specify and commit to purchase at least five percent (5%) (the "Purchasing Commitment") of its requirements of the products and services available through CSF specified in Exhibit A (the "Specified Product Categories"). Accordingly, Purchaser hereby agrees to comply with such Purchasing Commitment. Unless otherwise agreed by CSF, Purchaser acknowledges and agrees that Purchaser shall have access only to CSF purchasing agreements related to the Specified Product Categories. (b) Purchaser acknowledges and agrees that compliance with the Purchasing Commitment is a continuing condition precedent to its continued eligibility to be a Participant of CSF. Failure at any time to comply with this condition may result in termination by CSF of this Agreement; and upon any such termination, its ability to access CSF purchasing agreements shall be terminated. (c) CSF may from time to time request Participants to voluntarily commit to specific volumes for a particular product or service. However, except for the Purchasing Commitment of the Specified Product Categories, Purchaser is not required to use CSF for all of its purchases of any particular product or service. 5.3 Disclaimer. CSF shall have no liability or responsibility to Purchaser or its affiliates for the failure of goods or services purchased through CSF for delivery in a timely manner, availability to Purchaser or its affiliates of warranties pertaining to its purchase of goods or services, or defects of any kind or nature of goods purchased. ARTICLE 6: COMPLIANCE PROVISIONS 6.1 Adherence to CSF's Policies, Rules, Regulations, and Governance Documents. Purchaser shall comply with all of CSF's policies, rules, regulations, and governance documents, whether now in force or hereafter adopted or amended. 6.2 Conduct. Each party shall adhere to all applicable Federal, state, and local laws, rules, and regulations including, without limitation, 42 U.S.C. § 1320a-7b(b) (the "Federal Anti-Kickback Law"). Each party shall use best efforts to comply with any applicable safe harbors to the Federal Anti-Kickback Law. PURCHASER MAY HAVE AN OBLIGATION TO REPORT ANY DISCOUNTS IT RECEIVES AND GIVE INFORMATION UPON REQUEST AS A PARTICIPANT IN ACCORDANCE WITH 42 CFR§§ 1001.952 (h)(i) or(h)(2). 2 1 6 E I 6.3 Vendor Fees. CSF may receive fees from vendors (the "Vendor Fees") as a result of Purchaser's purchases. CSF shall not receive a fee of more than 30% of the value of such purchases (although the average CSF fee is in the 4%-5% range). 6.4 Regulatory Reports. CSF shall prepare and distribute a written Report detailing the amount of Vendor Fees CSF receives as a result of the purchase volume of Purchaser (broken down by vendor). The Report shall be distributed at least annually and is also available upon request. ARTICLE 7: MISCELLANEOUS PROVISIONS 7.1 Use of Trade Names. Purchaser has been advised and understands that CSF may adopt for use certain trade names, service marks, and trademarks (the "Names"). Purchaser will have the right to use any such Name, only in accordance with, and subject to, such limitations, standards, terms, and conditions as may be established by CSF from time to time and furnished in writing by CSF to Purchaser. In addition, CSF retains the right to prescribe the type and content of any materials of Purchaser that make use of any Name. 7.2 Purchaser Information. Purchaser agrees to supply information to CSF or the designated executive(s) of CSF, on a confidential basis, which CSF reasonably determines will assist it in providing the products and services contemplated by this Agreement, including, but not limited to, information relating to the volume of product, usage by product line and manufacturer, the price paid for products, and other similar data. 7.3 Product Transfers. Purchaser agrees not to directly or indirectly sell, transfer, assign, or otherwise convey products or services purchased through CSF to any person other than an affiliate of Purchaser. ARTICLE 8: INDEPENDENT CONTRACTOR Each party shall be regarded as an independent contractor for all purposes, including, without limitation, income tax and employment tax purposes, and shall represent such status to third parties. This Agreement shall not make either party an employee, partner, or joint venturer of or with the other. Except as provided herein, neither party shall bind or transact business in the other's name, or make representations or commitments on the other's behalf without prior written approval. ARTICLE 9: STANDARD PROVISIONS 9.1 Remedies. In the event of a breach of this Agreement by Purchaser, the parties acknowledge that the injury to CSF would be irreparable, and the monetary amount of damage therefrom would be difficult or impossible to determine. CSF shall have all remedies available at law or equity, specifically including, without limitation, entitlement as a matter of course to an injunction or similar equitable relief, without bond or with a nominal bond if allowed by law. 9.2 Avoidance of Violations; Modification. Notwithstanding any provision of this Agreement, the parties shall not violate any applicable laws, rules, or regulations, including those relating to Medicare, Medicaid, similar Florida programs, or the provision of health care or medical services. The parties shall modify this Agreement to the extent necessary to comply with such laws, rules, and regulations. 9.3 Confidentiality. Except to the extent required by law or court order, the parties agree to maintain strict confidentiality with regard to any and all information which comes into their possession as a result of this Agreement or any details pertaining to this Agreement. Notwithstanding the foregoing, each party shall have the right to disclose the relationship and general parameters of this Agreement. This provision shall survive the termination of this Agreement. Confidentiality of information contained in this Agreement is subject to the requirements of the Florida Public Records Act, Chapter 119, Fla. Stat., and the Florida Sunshine Law, Chapter 286, Ha. Stat. 3 1 6 E 1 9.4 Mutual Indemnification. To the extent permitted by applicable law, and without waiver of sovereign immunity protection, if any, each party (the "Indemnitor") shall indemnify the other party (the "Indemnitee") for any and all damages, liabilities, costs, and expenses (including, but not limited to, attorneys' fees) reasonably incurred by or awarded against Indemnitee which relate to a claim or proceeding against Indemnitee based solely on the negligent or wrongful conduct of Indemnitor (each, a "Claim"). This indemnification is effective only if (i) Indemnitee promptly notifies Indemnitor in writing of any known Claim, whether threatened or actual (or Indemnitor is not materially prejudiced by failure to receive prompt written notice of such Claim), (ii) Indemnitee fully cooperates with Indemnitor (at Indemnitor's expense) in the defense of any such Claim, (iii) Indemnitor controls the defense against any such Claim, unless the interests of the parties materially differ or Indemnitor's counsel is not reasonably acceptable to Indemnitee, and (iv) lndemnitee's damages, liabilities, costs, and expenses are not paid by insurance or otherwise covered by a third party. This provision shall survive the termination of this Agreement. The Foregoing indemnification shall not constitute a waiver of Purchaser's sovereign immunity beyond the limits set forth in Florida Statutes, §768.28. 9.5 Notices. Any notice required or permitted to be given under this Agreement shall be sufficient if given in writing and sent by certified mail, return receipt requested, to the parties at the following addresses (or at such other addresses as may be furnished from time to time): If to Purchaser, to: Collier County Board of County Commissioners, Florida Emergency Medical Services 8075 Lely Cultural Parkway Naples, Florida 34113 Attention: Artie Bay, Accounting Supervisor Phone: 239-252-3756 Email: Artie.Bay@,colliercountyfl.gov If to CSF, to: Cooperative Services of Florida, Inc. 2727 Winkler Avenue Fort Myers, FL 33901 Attention: Rita Lee Email: Rita.Lee@csofl.com with a copy to: Zach Buffington Williams, Parker, Harrison, Dietz&Getzen 200 S. Orange Avenue Sarasota, Florida 34236 9.6 Notice of Claims. A party shall give written notice to the other party, as soon as practicable, of any lawsuit, claim, or complaint which involves or may involve the other party. 9.7 Amendment. No amendment to this Agreement shall be effective unless it is in writing, attached to, or made a part of this Agreement, and executed by a duly authorized representative of each party. 9.8 Assignment. This Agreement and all of the provisions hereof shall be binding upon and inure to the benefit of the parties and their respective successors and permitted assigns. However, neither this Agreement nor any of the rights, interests, or obligations hereunder shall be assigned by any party hereto without the prior written consent of the other party. Notwithstanding the foregoing, this Agreement may be assigned by CSF to an entity controlling, controlled by, or under common control with CSF, without Purchaser's consent; however, written notice shall be given to Purchaser upon assignment. 9.9 Entire Agreement. This Agreement, along with the exhibits, schedules, documents, certificates, and instruments referred to herein, embodies the entire agreement and understanding of the 4 E 1 parties in respect of the transactions contemplated by this Agreement. There are no restrictions, promises, representations, warranties, covenants, or undertakings, other than those expressly set forth or referred to herein. This Agreement supersedes all prior agreements and understandings between the parties with respect to such transactions. 9.10 No Third Party Rights. This Agreement is intended solely for the benefit of the parties hereto and shall not be deemed to create any rights in any other person or entity. 9.11 Severability. If any provision or portion of this Agreement shall become invalid or unenforceable for any reason, there shall be deemed to be made such minor changes in such provision or portion as are necessary to make it valid or enforceable. The invalidity or unenforceability of any provision or portion hereof shall not affect the validity or enforceability of the other provisions or portions hereof. 9.12 Counterparts. This Agreement may be executed in any number of counterparts, each of which shall be deemed an original, but all of which shall constitute one instrument. A signed copy of this Agreement delivered by facsimile, email, or other means of electronic transmission shall be deemed to have the same legal effect as delivery of an original signed copy of this Agreement, and such signed copy shall be considered an original signed copy for all purposes. 9.13 Captions. The captions of this Agreement are for convenience only and are not a part of this Agreement and do not in any way limit or amplify the provisions of this Agreement. 9.14 Interpretation. Whenever the context of any provision shall require it, the singular number shall include the plural number, and vice-versa, and the use of any gender shall include any other or all genders as used in this Agreement. This Agreement has been negotiated at arms length. Any rule of law or legal decision that requires interpretation of ambiguities against the drafting party is not applicable and is hereby waived. The provisions of this Agreement shall be interpreted in a reasonable manner to effect the purpose of the parties to this Agreement. 9.15 Prevailing Party Entitled to Attorneys' Fees and Costs. To the extent limited by law, with regard to any legal disputes arising out of or related to this Agreement, the prevailing party shall receive from the non-prevailing party(ies) all reasonable legal fees, costs, charges, and expenses incurred, including reasonable attorneys'fees, whether from the initial request for redress or through trial, appeal, and collection. 9.16 Waiver of Compliance. Except as otherwise provided in this Agreement, any breach by a party may only be waived by the other party in a written instrument signed by the waiving party. Such waiver shall not operate as a waiver of, or estoppel with respect to, any subsequent or other breach. 9.17 Applicable Law and Courts. This Agreement shall be governed by the internal laws of the State of Florida (without regard to conflict of laws or similar concepts). Jurisdiction and venue shall lie, and all legal proceedings shall be brought, in the Twentieth Judicial Circuit in and for Collier County, Florida, or in the United States District Court for the Middle District of Florida. 9.18 Cooperation. The parties agree to cooperate and execute all documents to implement and carry out the provisions of this Agreement. 5 1 6 E 1 IN WITNESS WHEREOF, the parties have caused this Agreement to be duly executed on the day and year first above written. ATTEST: Crystal K.Kinsel, Clerk&Comptroller BOARD OF COUNTY COMMISSIONERS COLLIER �C4 -•RIDA Ce) / ....0 0 By: k ® _ IBY• — - +- ' W/ . McDaniel,Jr., Dated: ',IL s O !Ill C airman (SEAL) AtteSt'is to C `ai' , :1% signature*on y. Contractor's Witnesses: CONTRACTOR: ight i4-6(...-- Cooperative Services of Florida,Inc. First • itness By: Sign ure A� a tel TType/!rint witness nameT NN,S L'R&'evw) VP C., Type/print signature and titleT �r Ja.i< 2 , , • d Witn; ir � 04-1(44 Ylacri- /O Date — —7-91 , TType/print witness nameT App •v-d as . "o , and egality: • 1I Deput County tome ,44,1- ---4:1-4-x-- Print Name 6 16E EXHIBIT A SPECIFIED PRODUCT CATEGORIES 1. Medical Surgical Supplies 2. Environmental Supplies 3. Pharmaceuticals LeeSar will be the primary distributor of specified products listed above. 7 GO) LEESAINC 1 6 E ,1 A,„," CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)11/1/2018 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 Certificate Department Commercial Lines—(813)-639-3000 PHONE FAX (A/C.No,Ext): (A/C,No): 610.537.2400 USI Insurance Services National, Inc. ADDRESS: clw_certrequest@usi.com 2502 N.Rocky Point Drive INSURER(S)AFFORDING COVERAGE NAIC# Tampa,FL 33607 INSURER A: Federal Insurance Company 20281 INSURED INSURER B: Great Northern Insurance Company 20303 LeeSar,Inc. INSURERC: North River Insurance Company 21105 2727 Winkler Ave. INSURER D: INSURER E: Fort Myers,FL 33901 INSURER F: COVERAGES CERTIFICATE NUMBER: 13631160 REVISION NUMBER: See below 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 INSD WVD POLICY NUMBER (MM/DD/YYYY) (MMIDOIYYYY) A X COMMERCIAL GENERALLIABILITY X 3593-50-78 09/25/2018 09/25/2019DAMAGE TEACH OCCURRENCE $ 1,000,000 RENTED CLAIMS-MADE X OCCUR PREM SESO(Ea occurrence) $ 1,000,000 MED EXP(Any one person) $ 15,000 PERSONAL BADV INJURY _ $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ Excluded OTHER: B AUTOMOBILE LIABILITY 7498-61-46 09/25/2018 09/25/2019 COMBINED SINGLE LIMIT $ 1,000,000 X (Ea accident) _ X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS , X HIRED NON-OWNED PROPERTY DAMAGE—�$ AUTOS ONLY _ AUTOS ONLY (Per accident) $ C UMBRELLA LIAB X OCCUR 5821110162 09/25/2018 09/25/2019 EACH OCCURRENCE $ 15,000,000 x EXCESS LIAB CLAIMS-MADE AGGREGATE $ 15,000,000 DED RETENTION$ 0 WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVEN/A E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Collier County Board of County Commissioners,OR,Board of County Commissioners in Collier County,OR Collier County Government,OR Collier County included as an additional insured under the captioned Commercial General Liability and Automobile Liability Policies on a primary and non-contributory basis if and to the extent required by written contract. 19-001 VVV-"Medications for Emergency Medical Services" CERTIFICATE HOLDER CANCELLATION Collier County Board of County Commissioners SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 3295 Tamiami Trail E. ACCORDANCE WITH THE POLICY PROVISIONS. Naples,FL 34112 AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) (This certificate replaces certificate#136311596sued on 11/1/2018) 16E 1 1 ® DATE(MM/DD/YYYY) ACC)R o CERTIFICATE OF LIABILITY INSURANCE 12/18/2018 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 Alefa Kerry Lykes Insurance, Inc. PHONE FAX P.O. Box 60043 (A/c.No.Eat):239-931-3015 (A/c,No):239-931-5604 Fort Myers FL 33906-6043 ADDRESS: akerry@lykesinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Bridgefield Employers Ins Co. 10701 INSURED LEESA-2 INSURER B: LeeSar, Inc. 2727 Winkler Avenue INSURER C: Fort Myers FL 33901 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:888931703 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 LTRINSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE RENTED $ CLAIMS-MADE J OCCUR PREM SESO(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ _ POLICY PRO LOC PRODUCTS-COMP/OP AGG $ PRO- JECT _ OTHER: $ 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$ $ A WORKERS COMPENSATION 0830-54755 8/31/2018 8/31/2019 X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY OFFICER/MEMBER OPRIETO /PARTNERE ECUTIVE N N/A E.L.EACH ACCIDENT $1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Collier County included as additional insured under the contract#19-001 VW CERTIFICATE HOLDER CANCELLATION 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 County Commissioners 3295 Tamiami Trail E AUTHORIZED REPRESENTATIVE Naples FL 34112 i2VLri n ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD