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Backup Documents 04/14/2009 Item #16D 9 MEMORANDUM DATE: April 20, 2009 TO: Lyn Wood, Contract Specialist Purchasing Department FROM: Martha Vergara, Deputy Clerk Minutes and Records Department RE: Contract #08-5128 "Pharmacy Services" Contractor: Collier Health Services, Inc. 16D9 Enclosed, please find one (1) original, referenced above (Agenda Item #16D9) approved by the Board of County Commissioners on Tuesday, April 14, 2009, An original Agreement is being held in the Minutes and Records Department in the Official Records of the Board's If you should have any questions, you may contact me at 252-7240. 't, Thank you, Enclosures ITEM NO.: O1-?12C- 01170 FILE NO.: ROUTED TO: l-l..\t:. u\- \Hc_ VI [ \ J ,'"'_.-"II\\C, i'()\ lI,pv L 1 , ,.\[.1 \,,). . Ornn 'CO\( \ 1 ~'" \ \: 0 b Ll<U) h\ , DATE REcl~ 9 DO NOT WRITE ABOVE THIS LINE REQUEST FOR LEGAL SERVICES Date: April 14, 2009 Office of the County Attorney Jeff Klatzkow Lyn M. Wood, C.P.M., Contract Specialist y. L^ Purchasing Department, Extension 2667 U'1'(f' To: From: Re: Contract: 08-5128 "Pharmacy Services" Contractor: Collier Health Services, Inc. BACKGROUND OF REQUEST: This Contract was approved by the BCC on April 14, 2009, Agenda Item 16.0.9 This item has not been previously submitted. ACTION REQUESTED: Contract review and approval. OTHER COMMENTS: Please forward to BCC for signature after approval. If there are any questions concerning the document, please contact me, Purchasing would appreciate notification when the documents exit your office. Thank you. C: Terri Daniels, Human Services / 0/fi1 ~ vw. ~G.~ A r~f~~J r v/ej< ~.~ Reviewer Initials: {!U-~ Date' ,-"--17 --1.Jy 04-COA-Ol030/222 Entity Name: RLS# CHECKLIST FOR REVIEWING CONTRACTS (''dzt...td_~i7f .5t:Y'" )1..6; ,;;~--. Entity name correct on contract? ~""~c U f-m,: ~Yes Entity registered with FL See, of State? . k Y_ Yes ,~No v 1 J /)f(,"/ . "1 "u, ."'tL_e.~ \:.. '., ',{t.'11 /~,,",, [("'UA~)6es VYes 7Yes 'l_~__ Yes No Insurance Insurance Certificate attached? Insured registered in Florida" Contract # &/or Project referenced on Certificate? Certificate Holder name correct (BCC)? Commercial General Liability General Aggregate Required $~__ Products/Compl/Op Required $ ~l'tr...,/;,/,[, (I. Personal & Advert Required $~_ Each Occurrence Required $ ;,,(;Cf;t't.i{.' Fire/Prop Damage Required $___~_.. Automobile Liability Bodily [nj & Prop Required $ 3N\i'C'i Workers Compensation /frfu <' k l'-( Each accident Required $ ~ ___' ,;i Provided $ Disease Aggregate Required $ // Provided $ ~"~_..- Disease Each Empl Required $ ~ / Provided $ U mhrella Liability ~-/) 'CI. Each Occurrence Provided $ IJZ ';0 lv' Aggregate Provided $ ~,I!Z?':~'li/J Does Umbrella sufficiently cover any underinsured port. ,11', I Professional Liability Each Occurrence Required $ 2.'r)t.!r]Ofr Provided $ --.-i',~.._ Per Aggregate Required $_..~.. Provided $ Otber Insurance Each Occur Type:_ No No ;;: Provided $ Jdt'C',P''(' Provided $ 1.1.tJ(!,/t>:/.. Provided $~ Provided $~~ Provided $ ~.._n / Exp. Date _-,lllt'll', Exp. Date __E:_e.___ Exp. Date, ' __~ Exp. Date -:tllO( ~) Exp. Date ______ Provided $ ~ (if) t' u!'(' , Exp Date Exp Date Exp Date Exp Date Exp Date <f-I'JCIU Exp Date --'l..i'J..-'1 L' Yes No Exp. Date Exp, Date Required $ ,_ Provided $ County required to be named as additional insured? County named as additional insured? '/Yes ---:7Yes No No Indemnification Does indemnification meet County standards? Is County indemnifying other party" Yes Yes No No Performance Bond Bond requirement referenced in contract? If attached, expiration date ofbond Does dollar amount match contract? Agent registered in Florida? Yes No Yes Yes No No Signature Blocks Correct executor name in signature block? Correct title of executor? Executor authorized to sign for entity? Proper number of witnesses/notary? Authorization for executor to sign, if necessary: _ Chairman's signature block? Clerk's attestation signature block? County Attorney's signature block? Yes No Yes No Yes No Yes No Yes Yes Yes No No No Allachments Are all required attachments included? Yes No 1009 Q .. .i."'~" cc-" 1 > <S:h u) f;..:c'Jt1) )! . (jiZ(.hv}/fY 60~ - ,"'/VI Y c..-(>./V.ioVli~'>ICi'-'z.,-1i5 . , (I (.Vf,Zvf-l-<fl !' ' til...... ) iP [l.lljl.J If /' J .' ,'~ ".~" ' I ;PI/tv. ," liJUt-<<k/ . l.-fIe- q})i~ r, d;j.r~ 1#*. . 1-fL.r d.,;'<" , Lt f iff r<";t/" 1;(' 'rlt'I' frI- Exp Date_ 16D9 MEMORANDUM TO: FROM: Ray Carter Risk Management Department Lyn M. Wood, C.P.M., Contract Specialist)j? , Purchasing Department ~ DATE: April 14, 2009 RE: Review Insurance for Contract: 08-5128 "Pharmacy Services" Contractor: Collier Health Services, Inc. This Contract was approved by the BCC on April 14, 2009, Agenda Item 16.0.9 Please review the Insurance Certificates for the above referenced contract. If everything is acceptable, please forward to the County Attorney for further review and approval. Also, will you advise me when it has been forwarded. Thank you. If you have any questions, please contact me at extension 2667. dod/LMW C: Terri Daniels, Human Services DATE RECEIVED APR 1 5 2009 fiSk HAlWiEMENI 7 #rf/'/'.e, / , j I ' /<~~~~t: fliT/Cj'l www.sunbiz.org - Department of State Page I oD 1 9 Home Contact Us E-Filing Services Document Searches Forms Help pre~j~ys 0_" List NextQItLi$t BetumJo Ltst ev_~nt~ No Name History Entity Name Search Detail by Entity Name Florida Non Profit Corporation COLLIER HEALTH SERVICES, INC, Filing Information Document Number 739050 FEI Number 591741277 Date Filed 05/17/1977 State F L Status ACTIVE Last Event AMENDMENT Event Date Filed 03/29/1999 Event Effective Date NONE Principal Address 1454 MADISON AVE WEST IMMOKALEE FL 34142 US Changed 01/19/2007 Mailing Address POBOX 873 IMMOKALEE FL 34143 US Changed 04/08/1998 Registered Agent Name & Address DILLON, WILLIAM 2618 CENTENNIAL PL TALLAHASSEE FL 32308 US Name Changed: 06/21/1999 Address Changed: 03/03/2008 Officer/Director Detail Name & Address Title ST IRIZARRY. DIGNA 106 S 1 ST STREET SUITE 101 IMMOKALEE FL 34142 US Tille C BLACKBURN, DORIS 5203 SELBY DRIVE FORT MYERS FL 33919 US http://www.sunbiz.org/scripts/cordet.exe?action=D ETFI L&inq_ doc _l1umber=73 9050&in... 12/16/2008 www.sunbiz.org - Department of State TitleVD ALLEN SR, HOWARD 430 GAUNT STREET IMMOKALEE FL 34142 Title EV WEINMAN, STEVEN D 1454 MADISON AVENUE IMMOKALEE FL 34142 Title PCEO AKIN, RICHARD B 1454 MADISON AVENUE IMMOKALEE FL 34142 TitleVP ARAGONA, SHARON B 1454 MADISON AVENUE IMMOKALEE FL 34142 Annual Reports Report Year Filed Date 2007 01/19/2007 2007 10/01/2007 2008 03/03/2008 Document Images 03L03/2QQ8 --_ANNUAL RI;1"0R1 1 0101/20Q7 -- ANN1li\L REPOR.I Q1LJ9/2007 -- ANNUAL EL~PORT 03/20/200,,"--, Reg., Agent Change 01/17/2QQ6 -- ANNUAL RI;E'QRI 07/18/2005 =ANNUAL REPORT 01/14/2005." ANNUAL REPORT OS/25/2004 -- ANNUAL REPORT 04/30/2003.. ANNUj\L REPORT 02/11/2002.. ANNUAL REPORT 05/11/2Q01-= ANNUAL REPORT 03/14/2000 = ANNUAL REPORT 06121/1999 -- ANNUAL~Ef'QBT 03/29/1999 -- Amendment 02/01/1999-- ~ Agent Change 04/0811998-=ANNUAL REPDRT 04/30/t99Z -,_ANNUAL REPOfU 05(16/1996 =ANNUAL REPORT 05101/1995.. ANNUAL REPORT Page 2 of3 16D9 View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in peF format View image in PDF fo.rmat View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF formal View image in POF format View image in PDF format View image in PDF format View image in PDF format View image in POF format View image in PDF format Note: This is not official record. See documents jf question or conflict. http://www.sunbiz,org/scripts/cordet.exe?action=D ETFI I,&inq_ doc _numbcr=73 9050&in... 12/16/2008 www.sunbiz.org- Department of State Page 3 of3 16D9 Pr~yio~s on List N~xt on List Ret~rn To List l;)Lents No Name History Entity Nam~ S~arch Home Contact us Document Searches E-Filing Services Forms Help CODvright and Privacy Policies Copyright @ 2007 State of Florida, Department of Stale. http://www.sunbiz.org/scripts/cordel.exe?action= D ETFI L&in~ doc _ numbcr~73 9050& in... 12/16/2008 16D9 A G R E E MEN T 08-5128 for Pharmacy Services THIS AGREEMENT, made and entered into on this I L.f -th day of A p n' \ 2008, by and between Collier Health Services, Inc., authorized to do business in the State of Florida, whose business address is 1454 Madison Avenue, Immokalee, Florida 34142, hereinafter called the "Contractor" and Collier County, a political subdivision of the State of Florida, Collier County, Naples, hereinafter called the "County": WIT N E SSE T H: 1, COMMENCEMENT. This Agreement shall commence on the date of award by the Board of County Commissioners with an initial term of twelve (12) months The County may, at its discretion and with the consent of the Contractor, renew the Agreement under all of the terms and conditions contained in this Agreement for two (2) additional terms of two (2) years each. The County shall give the Contractor written notice of the County's intention to extend the Agreement term not less than ten (10) days prior to the end of the Agreement term then in effect. 2. STATEMENT OF WORK. The Contractor shall provide Pharmacy Services in accordance with the terms and conditions of RFP #08-5128 and the Contractor1s proposal referred to herein and made an integral part of this agreement and Exhibit A, Scope of Work attached to and made an integral part of this agreement. This Agreement contains the entire understanding between the parties and any modifications to this Agreement shall be mutually agreed upon in writing by the Contractor and the County project manager or his designee, in compliance with the County Purchasing Policy and Administrative Procedures in effect at the time such services are authorized. 3. COMPENSATION. The County shall pay the Contractor for the performance of this Agreement the aggregate of the units actually ordered and furnished at the unit price, together with the cost of any other charges/ fees submitted in the proposal, and set forth in Exhibit B, attached to and made an integral part of this Agreement. Any County agency may purchase products and services under this contract, provided sufficient funds are included in their budget(s), Page I of 10 16D9 Payment will be made upon receipt of a proper invoice and upon approval by the Project Manager or his designee, and in compliance with Chapter 218, Fla. Stats., otherwise known as the "Local Government Prompt Payment Act". 4. SALES TAX. Contractor shall pay all sales, consumer, use and other similar taxes associated with the Work or portions thereof, which are applicable during the performance of the Work. 5. NOTICES. All notices from the County to the Contractor shall be deemed duly served if mailed or faxed to the Contractor at the following Address: Collier Health Services, Inc. 1454 Madison Avenue Immokalee, Florida 34142 Attention: Mike Ellis, Director of Corporate Development Telephone: 239-658-3138 Facsimile: 239-658-3050 All Notices from the Contractor to the County shall be deemed duly served if mailed or faxed to the County to: Collier County Government Center Purchasing Department - Purchasing Building ::\301 Tamiami Trail, East Naples, Florida 34112 Attention: Steve Carnell, Purchasing/GS Director Telephone: 239-252-8371 Facsimile: 239-252-6584 The Contractor and the County may change the above mailing address at any time upon giving the other party written notification. All notices under this Agreement must be in writing, 6. NO PARTNERSHIP. Nothing herein contained shall create or be construed as creating a partnership between the County and the Contractor or to constitute the Contractor as an agent of the County. 7. PERMITS: LICENSES: TAXES, In compliance with Section 218.80, F.s., all permits necessary for the prosecution of the Work shall be obtained by the Contractor. Payment for all such permits issued by the County shall be processed internally by the County. All non-County permits necessary for the prosecution of the Work shall be procured and paid for by the Contractor. The Contractor shall also be solely responsible for payment of any and all taxes levied on the Contractor, In addition, the Contractor shall comply with all rules, regulations and laws of Collier County, the State of Florida, or the Page 2 of 10 16D9 u, S. Government now in force or hereafter adopted, The Contractor agrees to comply with all laws governing the responsibility of an employer with respect to persons employed by the Contractor. 8. NO IMPROPER USE. The Contractor will not use, nor suffer or permit any person to use in any manner whatsoever, County facilities for any improper, immoral or offensive purpose, 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 Contractor or if the County or its authorized representative shall deem any conduct on the part of the Contractor to be objectionable or improper, the County shall have the right to suspend the contract of the Contractor. Should the Contractor fail to correct any such violation, conduct, or practice to the satisfaction of the County within twenty-four (24) hours after receiving notice of such violation, conduct, or practice, such suspension to continue until the violation is cured. The Contractor further agrees not to commence operation during the suspension period until the violation has been corrected to the satisfaction of the County. 9, TERMINATION. Should the Contractor be found to have failed to perform his services in a manner satisfactory to the County as per this Agreement, the County may terminate said agreement immediately for cause; further the County may terminate this Agreement for convenience with a thirty (30) day written notice. The County shall be sole judge of non-performance. 10. NO DISCRIMINATION. The Contractor agrees that there shall be no discrimination as to race, sex, color, creed or national origin. 11. INSURANCE. The Contractor shall provide insurance as follows: A. Commercial General Liability: Coverage shall have minimum limits of $2,000,000 Per Occurrence, Combined Single Limit for Bodily Injury Liability and Property Damage Liability. This shall include Premises and Operations; Independent Contractors; Products and Completed Operations and Contractual Liability. B. Business Auto Liability: Coverage shall have minimum limits of $300,000 Per Occurrence, Combined Single Limit for Bodily Injury Liability and Property Damage Liability, This shall include: Owned Vehicles, Hired and Non-Owned Vehicles and Employee Non-Ownership, C. Workers' Compensation: Insurance covering all employees meeting Statutory Limits in compliance with the applicable state and federal laws. D. Professional Liability: Coverage shall have minimum limits of $2,000,000 per Occurrence. Page 3 of 10 16D9 Special Requirements: Collier County 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 Contractor during the duration of this Agreement, Renewal certificates shall be sent to the County thirty (30) days prior to any expiration date. There shall be a thirty (30) day notification to the County in the event of cancellation or modification of any stipulated insurance coverage. Contractor shall insure that all sub-Contractors comply with the same insurance requirements that he is required to meet. The same Contractor shall provide County with certificates of insurance meeting the required insurance provisions, 12. INDEMNIFICATION. To the maximum extent permitted by Florida law, the Contractor shall indemnify and hold harmless Collier County, its officers and employees from any and all liabilities, damages, losses and costs, including, but not limited to, reasonable attorneys' fees and paralegals' fees, to the extent caused by the negligence, recklessness, or intentionally wrongful conduct of the Contractor or anyone employed or utilized by the Contractor in the performance of this Agreement. This indemnification obligation shall not be construed to negate, abridge or reduce any other rights or remedies which otherwise may be available to an indemnified party or person described in this paragraph, This section does not pertain to any incident arising from the sole negligence of Collier County. 13, CONTRACT ADMINISTRATION. This Agreement shall be administered on behalf of the County by the Housing and Human Services Department/Social Services Program. 14, CONFLICT OF INTEREST: Contractor represents that it presently has no interest and shall acquire no interest, either direct or indirect, which would conflict in any manner with the performance of services required hereunder. Contractor further represents that no persons having any such interest shall be employed to perform those services. 15. COMPONENT PARTS OF THIS CONTRACT. This Contract consists of the attached component parts, all of which are as fully a part of the contract as if herein set out verbatim: Contractor's Proposal, Insurance Certificate, RFP #08-5128, Exhibit A, Scope of Work and Exhibit B, Pricing. 16. SUBJECT TO APPROPRIATION. It is further understood and agreed by and between the parties herein that this agreement is subject to appropriation by the Board of County Commissioners. Page 4 of JO 16D9 17. PROHIBITION OF GIFTS TO COUNTY EMPLOYEES. No organization or individual shall offer or give, either directly or indirectly, any favor, gift, loan, fee, service or other item of value to any County employee, as set forth in Chapter 112, Part III, Florida Statutes, Collier County Ethics Ordinance No. 2004-05, and County Administrative Procedure 5311. Violation of this provision may result in one or more of the following consequences: a, Prohibition by the individual, firm, and/ or any employee of the firm from contact with County staff for a specified period of time; b. Prohibition by the individual and/ or firm from doing business with the County for a specified period of time, including but not limited to: submitting bids, RFP, and/ or quotes; and, c. immediate termination of any contract held by the individual and/ or firm for cause, 18. IMMIGRATION LAW COMPLIANCE. By executing and entering into this agreement, the Contractor is formally acknowledging without exception or stipulation that it is fully responsible for complying with the provisions of the Immigration Reform and Control Act of 1986 as located at 8 U.s.e. 1324, et seq, and regulations relating thereto, as either may be amended. Failure by the Contractor to comply with the laws referenced herein shall constitute a breach of this agreement and the County shall have the discretion to unilaterally terminate this agreement immediately. 19. VENUE. Any suit or action brought by either party to this Agreement against the other party relating to or arising out of this Agreement must be brought in the appropriate federal or state courts in Collier County, Florida, which courts have sole and exclusive jurisdiction on all such matters. 20. OFFER EXTENDED TO OTHER GOVERNMENTAL ENTITIES. Collier County encourages and agrees to the successful proposer extending the pricing, terms and conditions of this solicitation or resultant contract to other governmental entities at the discretion of the successful proposer. 21. AGREEMENT TERMS. If any portion of this Agreement is held to be void, invalid, or otherwise unenforceable, in whole or in part, the remaining portion of this Agreement shall remain in effect. 22. ADDITIONAL ITEMS/SERVICES. Additional items and/ or services may be added to this contract upon satisfactory negotiation of price by the Contract Manager and Contactor, 23. DISPUTE RESOLUTION. Prior to the initiation of any action or proceeding permitted by this Agreement to resolve disputes between the parties, the parties shall make a good faith effort to resolve any such disputes by negotiation, The negotiation shall be attended by representatives of Contractor with full decision-making authority and by County's staff person who would make the presentation of any settlement reached during negotiations to County for approval. Failing resolution, and prior to the commencement of depositions in any litigation between the parties arising out of this Agreement, the parties shall attempt to resolve the dispute through Mediation before Page 5 of 10 16D9 an agreed-upon Circuit Court Mediator certified by the State of Florida. The mediation shall be attended by representatives of Contractor with full decision-making authority and by County's staff person who would make the presentation of any settlement reached at mediation to County's board for approval. Should either party fail to submit to mediation as required hereunder, the other party may obtain a court order requiring mediation under section 44.102, Fla. Stat. Any suit or action brought by either party to this Agreement against the other party relating to or arising out of this Agreement must be brought in the appropriate federal or state courts in Collier County, Florida, which courts have sole and exclusive jurisdiction on all such matters. 24. KEY PERSONNEl/PROTECT STAFFING: The proposer's personnel and management to be utilized for this project shall be knowledgeable in their areas of expertise. The County reserves the right to perform investigations as may be deemed necessary to insure that competent persons will be utilized in the performance of the contract. Firm shall not change Key Personnel unless the following conditions are met: (1) Proposed replacements have substantially the same or better qualifications and/ or experience, (2) that the County is notified in writing as far in advance as possible. Firm shall make commercially reasonable efforts to notify Collier County within seven (7) days of the change. The County retains final approval of proposed replacement personnel. Page 6 of 10 ......__..,---_.-._._~.."..~-.^_..~...,.__..,- 1609 IN WITNESS WHEREOF, the Contractor and the County, have each, respectively, by an authorized person or agent, hereunder set their hands and seals on the date and year first above written. ATTEST: 11__" .,'11" 'v~~. -.. , . <~ j' BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY, FLORIDA By:, $~ J~ Donna Fiala, Chairman Collier Health Services, Inc. First Witness ~ VI 0:'. conuo'}f! B~ - Signature JJ:;.~~.J Sharon B. Aragona Type! print witness name U~.IJ/VL, ~. Air Second Witness Mike Ellis, Director of Community Typed signature and title Development Victoria Carr Type! print witness name Approved legal suffic n ....... mey \J.J< -' , Page 7 of 10 16D9 EXHIBIT A SCOPE OF WORK 1. Each of the Contractor's pharmacists must possess a current license from the Florida State Board of Pharmacy in accordance with Revised Statutes of the State of Florida, and shall maintain said license in good standing for the duration of the contract. 2. The Contractor shall provide at no additional cost to the county, pharmacy services at locations in areas which are not evacuated during a disaster, and be prepared to accept telephonic requests from the County Emergency Operations Center and fill such requests. Collier County Housing and Human Services Department/Social Services Program will be responsible for the pick-up and delivery of any such prescriptions. 3. The Contractor must be able to fill outpatient prescriptions as needed, each day for the duration of the contract within normal work hours of 8 am to 5 pm, 4, The Contractor shall be able to provide Generic equivalent drugs when one is available to fill the prescriptions, Prescriptions are limited to a 3D-day supply. 5. The Contractor shall provide electronic transfer of invoices (billing) to a local PC by-mail at least monthly per Clerk of Court's Finance standards. Such electronic data transfer capability shall be operational within two (2) months of contract start-up and the first billing shall be forthcoming within eight (8) weeks after start up of contract. The Contractor shall provide a contact name and phone number for technical assistance when file format problems arise. 6. The Contractor shall allow Collier County Housing and Human Services Department/Social Services Program direct Internet access to pharmacy data base for client profiles, prior authorizations, overrides, add/ change client information, change eligibility dates and ability to back date ending date, and contact name, telephone number and e-mail address to advise of change of client's social security number. 7. The Contractor shall use File Transfer Protocol (FTP), or other HIP AA compliant compatible programs to transfer encrypted client information (automatically) to pharmacy database at least twice daily, without breaking security. Full file transfer shall be done weekly. Contractor must comply with HIP AA 834 file format. 8. All of the Contractor's pharmacy locations shall be connected on a common network using the same database in order to monitor patient information and manage the formulary. In addition, all locations must be connected to the central system that contains client information. All clients will be given a voucher to provide to the pharmacy. Any physician can write a prescription; this includes Primary Care, specialists, emergency room physicians, dentists, etc, Collier County Housing and Human Services/Social Services will not pay for prescriptions if the client does not present a voucher which shows a valid begin and end date of eligibility. Page 8 of 10 16D9 9. Under the Health Insurance Portability and Accountability Act (HIPAA) of 1996, Contractor is expected to adhere to the same standards as the County and other HIP AA covered entities regarding the protection and non- authorized disclosure of Protected Health Information (PHI). 10. It is highly desirable that the Contract Manager be a pharmacist. The Contract Manager for Collier Health Services, Inc. will be Mike Ellis at telephone number 239-658-3138 and email address mellis@collier.org. 11. The Contractor shall identify rebates that are forthcoming and any savings realized from manufacturers rebates shall be credited against the County's monthly invoice, 12. Payments shall be made in accordance with the Local Government Prompt Payment Act from a joint revolving account for the payment of services provided. 13. The Contractor shall fill all medications to patients for self-administration in accordance with all applicable Federal, State and Local laws. 14, The Contractor shall update and make readily retrievable at any time, all outpatient and drug data within the outpatient profile as each prescription is filled or refilled. The contractor shall automatically monitor drug allergies and interactions according to data available for each patient. 15. The Contractor shall provide monthly Utilization and Administrative reports including number of prescriptions filled, covered individuals, utilizing individuals including physician dispensing profiles and other reports. 16, The Contractor must immediately advise the County whenever abuse, drug seeking or fraudulent behavior is suspected. 17. The Contractor shall provide to the County any manufacturer's no cost, discounted or promotional health care items, which may be provided to them during the period of the contract. 18, The Contractor shall be available for periodic site visits by Collier County staff, to any of their locations, in order to monitor the quality of services provided, 19, The Contractor must respond within twenty-four (24) hours to all questions presented by the Collier County Housing and Human Services Department. 20. The Contractor shall provide outpatient-packaging materials, including labeling, that meets all applicable laws and regulations. Labeling for outpatient packaging shall include: Page 9 of 10 a. Patient Name b. Date of Dispensing c. Prescription Number d. Physician's Name e. Instructions for Patient Use f. Name and Strength of Drug g. Number of Doses Dispensed 16D9 21. The contractor shall maintain all outpatient drug profiles on a computerized dispersing system. Each outpatient drug profile must include: a. Patient Name b. Address c. Phone d. Birth Date/Social Security Number e. Sex f. Allergies g, Prescription Number Drug data within each outpatient drug profile must include: a. Drug Name b. Drug Strengths c. Amount Ordered d, Amount Dispensed e. Instructions for Use f. Refills Authorized g. Physician Information h. Times and Dates Filled Electronic invoice data must include, but may not be limited to: a, Patient Name (Last, First, MI) b, SSN c. NABP # d, Store # e. RX# f. Date Filled (MM/DD/CCYY) g. Refill h. Physician Name 1. Drug J. NDC # and Description k. Quantity I. Days Supply m. Generic (Y/N) n, Amount Due 0, Billing Date Page 10 of 10 1 QrP}tm ACORD,. CERTIFICATE OF LIABILITY INSURANCE 3/30/2009 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, __ .INSUFlERS AFFOR[)ING~OVER,',A",GE. ., ''; - '" I NAIG# J!i?Uf<.ERA: ~ar~~or~iE....~_!!">!l_Ll~<mce Co an . 19682 __ ~i!RER B:",2.I"ar~_t~_~~",cas.1.l:I:l:,L;,i::Y, Insurance .,S-?'_n_.._ ,__LX~J~~ ~_____ 1_~URERC_}~_~~?~~~~,d Empl,?x_erslns Co .____ _~?S1_1______'"_,__ ~~----_.,'" -~~ . -,,---- -.-..-. , INSURf.R E: I fJA TE IMM/ODNYVYl PRODUCER Wells Fargo Ins Services Southeast, Inc. 27299 Riverview Center Blvd suite 211 Bonita Springs FL 34134-4322 {239) 498-5225 (239) 949-3575 INSURED Collier Health Services. Inc. 1454 Madison Avenue lmmokalee. FL 34142 COVERAGES THE POLICIES OF INSURANCE LISTED BELQWHAVE BEEN ISSUED TO THE INSURED NAMED ABOV[ rOR THE FOllCY PERIOD INDICATED NONJITHSTANDtNG ANY REQUIREMENT, TERM OR CONDITION or ANY CONTRACT OR On-IER DOCUMENT WITH RESPECT fQ WHICH THIS CERTIFICATE MAY 8E ISSUED OR MAY PERTAIN, THE INSURANCE AFf:ORDED BY THE POLICIES Or::SCR18ED HEREIN IS SUBJECT TO AIL n-IE TERMS, EXCLUSIONS AND Cm~OITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INfR D[V--'-'~-'- -'-~--"~--- -------;~LlCy NUMBER "POk+~Y ,i~FEcnV-E-1 Pgk~YEXP;tA~~14 i ------~,;:;;~--- _n__.__ GENERAl LIABILITY EACH OCCURRENCE I $ x 1 21UUNAG2894 4/1/2009 4/1/2010 I DAMAGE-'n:f~t:~--!-$- ~~lM~~,:;~~~:E~r;~~:: li:~2::~:E:::::~i: ! J !__~EONEF3^L_~Q.~~~Q~~~,- r~EN'L AGGREGATE L1M1T-;~~~~S PE-R PRQ9.i:!S::~..f_9MPIS?P AGG I X POLICY --- PRO-i ,LaC ~TOMOB\LE LIABILITY 1_ I ANY Aura I ALL O\<\iNED AUTOS r I A J_."Qil_Q.J_P_Q.9_u ,,~.QQ.!..9.EO 10.,000 1, D_D~~"Q.Q.g. . ~fg_~0_!"O_0_9 2,000,000 A 21lJUNAG2894 4/1/2009 4/1/2010 COMEJjNED SII\'GLE LIMIT !(EaaCCidenO f.._~.' , I DODIL Y INJURY, ~rscn) .?,"~"g 0,.?..t P_9~, , SCHEDULED A,UIOS X HIRED AUTOS X NON-OWNED AUTOS X DEDUCT~_~L.E._..~~..._ : BODILY INJURY : (Peraccide<ll) .---..-" , i PROF'ERTY DAMAGE (Peracciderll) I' $ GARAGE LIABILITY -~ ANY AUTO 1 , ~ESSIUMBRELL~~!..~BILlTY B X i OCCUR i ! CLAIMS MADE: 'AUTO~!'_:f~.!-.~~,IC)!,,~_T__. ~.__ OTHER -HAN AUTQONLY EAACC:S -f---- AGG i $ EACH OCCURRENCE ~s 5,000,000. _ ~f_~.~O-, qr~o 21HHUTT9047 4/1/2009 4/1/20.10 AGGREGI\TE i-- ______2 83028927 4/1/2010 $ '~--~--I-,-' ~_._~-----"----- -t---------- " CTH., -~~ : DEDUCTIBLE X RETENTION 10,000 C 'WORKERS COMPENSATION AND i EMPLOYERS' LIABILITY , ANY PROPRIETOR/PARTNER/EXECUTIVE ! -oFFICERlMEMBER EXCLUDED? , .fyes,describeunder SPECIAL PROVISIONS below OTHER 4/1/2009 x TWC~TfJN' 1'..L_ EACH ACCIDENT , E.L DISEASE - EA EMPLOYEE! S rnEl. '~I~~ASE" POLICY LlMI~T~ 1,_{)_9_~!.999_ _._~.OOO, 000 1,QOO,000 DESCRIPTION OF OPERATlONS! LOCATIONS! VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROViSIONS Certificate Holder is Additional Insured as rospects General Liability and Umbrella Liability Re: Agreement 08-5128 for Pharmacy Services CERTIFICATE HOLDER CANCELLATION SHOULD ANY Of THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Collier County Board of County Commissio~@rs NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Naples, Florida IMPOSE NO OBLIGATION OR LIABILITY OF ANY K\NO UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESE:NTATlV'" f.iJZ))J , ACORD 25 (2001/08) @ACORD CORPORATION 1988 PaSJ'" 1 of 2 16D9 3/30/2009 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies} must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemenl(s). 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)_ DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/OB) Page:> of 1 /4...."""'. ( ~ '. ~ '....Ian DEPARTMENl' OF HEALTH & HUMAN SERVICES 1609 ' Health Resources and ServIces Administration DEe 1 6 2008 Bureau of Primary Health Care Rockville MD 20857 Reference: Malpractice Liability Coverage - Renewal Health Center Deeming Letter Coverage Effective January 1, 2009 through December 31, 2009 Dear Executive Director: The Health Resources and Services Administration (HRSA) in accordance with Section 224(g) of the Public Health Service (PHS) Act, 42 U.S.C. ~233(g), as amended by the Federally Supported Health Centers Assistance Act of 1995 (FSHCAA), (P.L. 104-73), deems the entities listed on the attachment(s)to be employee's of the PHS, for the purposes of section 224, effective January 1, 2009. Section 224(a) provides liability protection under the Federal Tort Claims Act (FTCA) for damage for personal injury, including death, resulting from the performance of medical, surgical, dental, and related functions and is exclusive of any other civil action or proceeding. The 1995 amendments to FSHCAA clarified that FTCA coverage extends to deemed health centers and their: (1) officers; (2) governing board members; (3) ful1- and part-time health center employees; (4) licensed or certified health care practitioner contractors (who are not corporations) providing full-time services (i,e., on average at least 32 ~ hours per week); and (5) licensed or certified health care practitioner contractors (who are not corporations) providing part-time services in the fields of family practice, general internal medicine, general pediatrics, or obstetrics/gynecology. Volunteers are neither employees nor contractors and, therefore, are not eligible for FTCA coverage. In addition, FTCA coverage is comparable to an "occurrence" policy without a monetary cap, Therefore, any coverage limits that may be mandated by other organizations are met. ,__ _"'M"___~' __..,___. ..~"_.~,~ ,,_"~"H..._."~'_~"'_"'_'" -' "__"~,__~____",~_.^,~",-<~"_",_."_._,-,,.__..._.__."____._._.,--_.._,.~_.,-_."._>-*._---_..,~ 16D9 This action is based on the assurances provided in your FTCA deeming application, as required under 42 U.S.C, ~233(h), with regard to : (l) implementation of appropriate policies and procedures to reduce the risk of malpractice; (2) implementation of a system whereby professional credentials and privileges, references, claims history, fitness, professional review organization findings, and licensure status of health professionals are reviewed and verified; (3) cooperation with the Department of Justice (DOJ) in the defense of claims and actions to prevent claims in the future; and (4) cooperation with DOJ in providing information related to previous malpractice claims history. Deemed health centers must continue to receive funding under Section 330 of the PHS Act, 42 U.S.C. 5254(b), in order to maintain FTCA coverage. If the deemed entity loses its Section 330 funding, its coverage under the FTCA will end immediately upon termination of the grant, In addition to the FTCA statutory and regulatory requirements, every deemed health center is expected to follow HRSA's FTCA- related policies and procedures included on the enclosed list, These documents can be found online at http://www.bphc.hrsa.gov/pinspals/default.htm. For further information, please contact the Office of Quality and Data at 301-594-0818. Sincerely, l\....u..t.\..1.-,I'\.b. +- James Macrae Associate Administrator Enclosure Executive Director Center for Family Health. Inc, UDS# 057030 2298 Spring port Road, Suite B Jackson, MI 49202 Battle Creek, M I 49037 Executive Director Muskegon Family Care UDS# 0516820 2201 South Getty Street Muskegon Heights, MI49444 Executive Dlfector Collier Health Services, Inc, UDS# 041700 1454 Madison Avenue.West Immokalee, FL 34142 Executive Director Mattapan Community Health Center UDS# 01201 0 1425 Blue Hill Avenue Boston, MA 02126 Executive Director Northwest Buffalo Community Health Care Ctr UDS# 02001 0 155 Lawn Avenue Buffalo, NY 14207 Executive Director Centro de Salud Familiar Dr.Juli Palmieri Ferri,lnc. UDS# 020150 P.O. Box 450 Arroyo, PR 00714-0450 Executive Director Tri County Medical Center, Inc. UDS# 042830 316 South Main Street, P.O. Box 726 Evergreen, AL 36401 Executive Director Chota Community Health Services, Inc, UDS# 044251 0 1206 Hwy411 Vonore, TN 37885 Executive Director Metro Community Provider Network UDS# 080730 3701 South Broadway En9lewood, CO 80113 Executive Director Los Barrios Unidos Community Clinic, Inc, UDS# 060680 809 Singleton Boulevard Dallas, TX 75212 Executive Director lake County Health Department And Communtty Heatth Center UDS# 058870 3010 Grand Avenue Waukegan, IL 60085 Executive Director Community Clinic of Maui, Inc, UDS# 096040 48 Lono Avenue Kahului. HI 96732 Executive Director Unrty Health System UDS# 023890 39 Genesee Street Rochester, NY 14611 Executive Direclor JWCH Institute. Inc. UDS# 0925360 1910 West Sunset Boulevard. Suile 650 Los Angeles, CA 90026 Executive Director Junta Del Centro De Salud Comunal Or. Jose S. Belaval, Inc. UDS# 02Q700 2003 Borlnquen Avenue, P.O. Box 14451 San Juan, PR 00916 Execuuve Direclor Paterson Community Healtti Center, Inc, UDS# 021300 32 Clinton Street Paterson, NJ 07522 Executive Director CAMcare Health Corporation UDS# 021280 817 Federal Street Camden, NJ 08103 Executive Director Scranton Primary Health Care Center, Inc, UDS# 032560 959 Wyoming Avenue, P.O. Box 31 Scranton, PA 18501,0031 Executive Director Minnie Hamilton Health Care Center, Inc, UDS# 034190 186 Hospital Drive Grantsville, WV 26147,7100 Executive Director Covenant House Under 21 UDS# 021770 460 West 41" Street New York, NY 10036-6801 16D9 Executive Director Community Action Agency of Columbiana County, Inc UDS# 056820 7880 Lineole Place Lisbon, OH 44432 Executive Director Sebastlcook Family Doctors UDS# 015170 118 Moosehead Trail, Suile 5 Newport. ME 04953 Executive Director Herrtage Heallh & Housing, Inc, {dba Herilage Health Care Cenler} UDS # 020130 1727 Amslerdam Avenue New York, NY 10031 Executive Director Morovis Community Health Center, Inc. UDS# 022230 2 Calle Palron, P,O. Box 518 Moroilis, PR 00687 Executive Director Family Healthcare Center UDS# 083670 306 4th Street,North Fargo, ND 58102 Executive Director McKinney Community Health Center, Inc, UDS# 048080 218 Quarterman Street Waycross, GA 31503 Executive Director Newark Community Health Centers, Inc, UDS# 020500 741 Broadway Newark, NJ 07104 Executive Director Southwest Community Health Center UDS# 098790 751 Lombardi Court, Suite B Santa Rosa, CA 95407 Executive Director Yellowstone City County Health Department UDS# 082500 123 South 27" Street Billings, MT 59101 Executive Director Atascosa Health Center (AHC) UDS# 062390 310 West Oaklawn Road Pleasanton, TX 78064 .~ """,_"~",_,<",_",.",__~__",~""~_,~,,_,,,~,~,,,"'"_~,.,..._,."......_,,,,,,,_,".,,_"",""'''_,,~o~_''~_''_'_~~''_~.__~ 16D9 Health Resources and Serv~ces Adm~n~strat~on Federal Tort Claims Act (FTCA)-Related Program Assistance Letters (PALs) And Pol~cy Informat~on Not~ces (PINs) This list highlights the PALs and PINs most relevant for FTCA- related matters. Please consult HRSA's Web Site at http://www.bphc,hrsa.gov/pinspals/default.htm for a listing of all HRSA PALs and PINs. PALs 1999-15 2005-01 PINs 1999-08 2001-11 2001-16 2001-19 2002-07 2002-22 2002-23 Questions and Answers on the Federal Tort Claims Act Coverage for Section 330 Deemed Grantees Federal Tort Claims Act Policy Clarification on Coverage of Corporations Under Contract with Health Centers Health Centers and the Federal Tort Claims Act Clarification of Policy for Health Centers Deemed Covered Under the Federal Tort Claims Act for Medical Malpractice Credentialing and Privileging of Health Center Practitioners Procedure for Handling Subpoenas and Other Requests for Testimony of Health Center Employees in Private Litigation Scope of Project Policy Clarification of Bureau of Primary Health Care Credentialing and privileging Policy Outlined in Policy Information Notice 2001-16 New Requirements for Deeming Under the Federally Supported Health Centers Assistance Act Updated: July 9, 2007 MEMORANDUM DATE: May 6, 2009 TO: Lyn Wood, Contract Specialist Purchasing Department FROM: Teresa Polaski, Deputy Clerk Minutes and Records Department RE: Contract #08-5128 "Pharmacy Services" Contractor: Sunshine Pharmacy, Inc. 16D9 Enclosed, please find one (1) original, referenced above (Agenda Item #16D9) approved by the Board of County Commissioners on Tuesday, April 14, 2009. An original Agreement is being held in the Minutes and Records Department in the Official Records of the Board's If you should have any questions, you may contact me at 252-8411. Thank you, Enclosures MEMORANDUM 16D9 TO: FROM: Ray Carter Risk Management Department Lyn M. Wood, C.P.M., Contract specialist;/!.. .,~ Purchasing Department '~ April 15, 2009 DATE: RE: Review Insurance for Contract: 08-5128 "Pharmacy Services" Contractor: Sunshine Pharmacy, Inc. This Contract was approved by the BCC on April 14, 2009, Agenda Item 16.0.9 Please review the Insurance Certificates for the above referenced contract. If everything is acceptable, please forward to the County Attorney for further review and approval. Also, will you advise me when it has been forwarded. Thank you. If you have any questions, please contact me at extension 2667. dod/LMW C: Terri Daniels, Human Services DATE RECEIVED APR 1 6 2009 RISK ~ ~,:; :fJ'lW 16D9 A G R E E MEN T 08-5128 for Pharmacy Services THIS AGREEMENT, made and entered into on this J 4~ day of ~n '( 2009, by and between Sunshine Pharmacy, Inc., authorized to do business in the State of Florida, whose business address is 5482 Rattlesnake Hammock Road, Naples, Florida 34113, hereinafter called the "Contractor" and Collier County, a political subdivision of the State of Florida, Collier County, Naples, hereinafter called the "County": WIT N E SSE T H: 1. COMMENCEMENT. This Agreement shall commence on the date of award by the Board of County Commissioners for an initial term of twelve (12) months. The County may, at its discretion and with the consent of the Contractor, renew the Agreement under all of the terms and conditions contained in this Agreement for two (2) additional terms of two (2) years each. The County shall give the Contractor written notice of the County's intention to extend the Agreement term not less than ten (10) days prior to the end of the Agreement term then in effect. 2. STATEMENT OF WORK. The Contractor shall provide Pharmacy Services in accordance with the terms and conditions of RFP #08-5128 and the Contractor's proposal referred to herein and made an integral part of this agreement and Exhibit A, Scope of Work, attached to and made an integral part of this Agreement. This Agreement contains the entire understanding between the parties and any modifications to this Agreement shall be mutually agreed upon in writing by the Contractor and the County Project Manager or his designee, in compliance with the County Purchasing Policy and Administrative Procedures in effect at the time such services are authorized. 3. COMPENSATION. The County shall pay the Contractor for the performance of this Agreement the aggregate of the units actually ordered and furnished at the unit price, together with the cost of any other charges/ fees submitted in the proposal, and set forth in Exhibit B, attached to and made an integral part of this Agreement. Any county agency may purchase products and services under this contract, provided sufficient funds are included in their budget(s). Page 1 of 10 l6D9 Payment will be made upon receipt of a proper invoice and upon approval by the Project Manager or his designee, and in compliance with Chapter 218, Florida. Statutes, otherwise known as the "Local Government Prompt Payment Act". 4. ELECTRONIC BILLING. Contractor will invoice the County through the use of the Pharmacy Benefit Manager, a web based software system operated by GeriScriptRX. 5. SALES TAX. Contractor shall pay all sales, consumer, use and other similar taxes associated with the Work or portions thereof, which are applicable during the performance of the Work. 6. NOTICES. All notices from the County to the Contractor shall be deemed duly served if mailed or faxed to the Contractor at the following Address: Sunshine Pharmacy, Inc. 5482 Rattlesnake Hammock Road Naples, Florida 34113 Attention: Delmer H. Parrish, President Telephone: 239-775-6800 Facsimile: 239-775-7377 All Notices from the Contractor to the County shall be deemed duly served if mailed or faxed to the County to: Collier County Government Center Purchasing Department - Purchasing Building 3301 Tamiami Trail, East Naples, Florida 34112 Attention: Steve Carnell, Purchasing/ GS Director Telephone: 239-252-8371 Facsimile: 239-252-6584 The Contractor and the County may change the above mailing address at any time upon giving the other party written notification. All notices under this Agreement must be in writing. 7. NO PARTNERSHIP. Nothing herein contained shall create or be construed as creating a partnership between the County and the Contractor or to constitute the Contractor as an agent of the County. 8. PERMITS: LICENSES: TAXES. In compliance with Section 218.80, F.5., all permits necessary for the prosecution of the Work shall be obtained by the Contractor. Payment for all such permits issued by the County shall be processed internally by the County. All non-County permits necessary for the prosecution of the Work shall be procured Page 2 of 10 16D9 and paid for by the Contractor. The Contractor shall also be solely responsible for payment of any and all taxes levied on the Contractor. In addition, the Contractor shall comply with all rules, regulations and laws of Collier County, the State of Florida, or the U. S. Government now in force or hereafter adopted. The Contractor agrees to comply with all laws governing the responsibility of an employer with respect to persons employed by the Contractor. 9. NO IMPROPER USE. The Contractor will not use, nor suffer or permit any person to use in any manner whatsoever, County facilities for any improper, immoral or offensive purpose, 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 Contractor or if the County or its authorized representative shall deem any conduct on the part of the Contractor to be objectionable or improper, the County shall have the right to suspend the contract of the Contractor. Should the Contractor fail to correct any such violation, conduct, or practice to the satisfaction of the County within twenty-four (24) hours after receiving notice of such violation, conduct, or practice, such suspension to continue until the violation is cured. The Contractor further agrees not to commence operation during the suspension period until the violation has been corrected to the satisfaction of the County. 10. TERMINATION. Should the Contractor be found to have failed to perform his services in a manner satisfactory to the County as per this Agreement, the County may terminate said agreement immediately for cause; further the County may terminate this Agreement for convenience with a thirty (30) day written notice. The County shall be sole judge of non-performance. 11. NO DISCRIMINATION. The Contractor agrees that there shall be no discrimination as to race, sex, color, creed or national origin. 12. INSURANCE. The Contractor shall provide insurance as follows: A. Commercial General Liability: Coverage shall have minimum limits of $2,000,000 Per Occurrence, Combined Single Limit for Bodily Injury Liability and Property Damage Liability. This shall include Premises and Operations; Independent Contractors; Products and Completed Operations and Contractual Liability. B. Business Auto Liability: Coverage shall have minimum limits of $300,000 Per Occurrence, Combined Single Limit for Bodily Injury Liability and Property Damage Liability. This shall include: Owned Vehicles, Hired and Non-Owned Vehicles and Employee Non-Ownership. C. Workers' Compensation: Insurance covering all employees meeting Statutory Limits in compliance with the applicable state and federal laws. D. Professional Liability: Coverage shall have minimum limits of $2,000,000 per Page 3 of 10 16D9 Occurrence. Special Requirements: Collier County 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 Contractor during the duration of this Agreement. Renewal certificates shall be sent to the County thirty (30) days prior to any expiration date. There shall be a thirty (30) day notification to the County in the event of cancellation or modification of any stipulated insurance coverage. Contractor shall insure that all sub-Contractors comply with the same insurance requirements that he is required to meet. The same Contractor shall provide County with certificates of insurance meeting the required insurance provisions. 13. INDEMNIFICATION. To the maximum extent permitted by Florida law, the Contractor shall indemnify and hold harmless Collier County, its officers and employees from any and all liabilities, damages, losses and costs, including, but not limited to, reasonable attorneys' fees and paralegals' fees, to the extent caused by the negligence, recklessness, or intentionally wrongful conduct of the Contractor or anyone employed or utilized by the Contractor in the performance of this Agreement. This indemnification obligation shall not be construed to negate, abridge or reduce any other rights or remedies which otherwise may be available to an indemnified party or person described in this paragraph. This section does not pertain to any incident arising from the sole negligence of Collier County. 14. CONTRACT ADMINISTRATION. This Agreement shall be administered on behalf of the County by the Housing and Human Services Department/Social Services Program. 15. CONFLICT OF INTEREST: Contractor represents that it presently has no interest and shall acquire no interest, either direct or indirect, which would conflict in any manner with the performance of services required hereunder. Contractor further represents that no persons having any such interest shall be employed to perform those services. 16. COMPONENT PARTS OF THIS CONTRACT. This Contract consists of the attached component parts, all of which are as fully a part of the contract as if herein set out verbatim: Contractor's Proposal, Insurance Certificate, RFP #08-5128, Exhibit A, Scope of Work, and Exhibit B, Pricing. 17. SUBJECT TO APPROPRIATION. It is further understood and agreed by and between the parties herein that this agreement is subject to appropriation by the Board of County Commissioners. Page 4 of 10 16D9 18. PROHIBITION OF GIFTS TO COUNTY EMPLOYEES. No organization or individual shall offer or give, either directly or indirectly, any favor, gift, loan, fee, service or other item of value to any County employee, as set forth in Chapter 112, Part III, Florida Statutes, Collier County Ethics Ordinance No. 2004-05, and County Administrative Procedure 5311. Violation of this provision may result in one or more of the following consequences: a. Prohibition by the individual, firm, and/ or any employee of the firm from contact with County staff for a specified period of time; b. Prohibition by the individual and/ or firm from doing business with the County for a specified period of time, including but not limited to: submitting bids, RFP, and/ or quotes; and, c. immediate termination of any contract held by the individual and/ or firm for cause. 19. IMMIGRATION LAW COMPLIANCE. By executing and entering into this agreement, the Contractor is formally acknowledging without exception or stipulation that it is fully responsible for complying with the provisions of the Immigration Reform and Control Act of 1986 as located at 8 U.s.e. 1324, et seq. and regulations relating thereto, as either may be amended. Failure by the Contractor to comply with the laws referenced herein shall constitute a breach of this agreement and the County shall have the discretion to unilaterally terminate this agreement immediately. 20. VENUE. Any suit or action brought by either party to this Agreement against the other party relating to or arising out of this Agreement must be brought in the appropriate federal or state courts in Collier County, Florida, which courts have sole and exclusive jurisdiction on all such matters. 21. OFFER EXTENDED TO OTHER GOVERNMENTAL ENTITIES. Collier County encourages and agrees to the successful proposer extending the pricing, terms and conditions of this solicitation or resultant contract to other governmental entities at the discretion of the successful proposer. 22. AGREEMENT TERMS. If any portion of this Agreement is held to be void, invalid, or otherwise unenforceable, in whole or in part, the remaining portion of this Agreement shall remain in effect. 23. ADDITIONAL ITEMS/SERVICES. Additional items and/ or services may be added to this contract upon satisfactory negotiation of price by the Contract Manager and Contactor. 24. DISPUTE RESOLUTION. Prior to the initiation of any action or proceeding permitted by this Agreement to resolve disputes between the parties, the parties shall make a good faith effort to resolve any such disputes by negotiation. The negotiation shall be attended by representatives of Contractor with full decision-making authority and by County's staff person who would make the presentation of any settlement reached during negotiations to County for approval. Failing resolution, and prior to Page 5 of 10 16D9 the commencement of depositions in any litigation between the parties arising out of this Agreement, the parties shall attempt to resolve the dispute through Mediation before an agreed-upon Circuit Court Mediator certified by the State of Florida. The mediation shall be attended by representatives of Contractor with full decision- making authority and by County's staff person who would make the presentation of any settlement reached at mediation to County's board for approval. Should either party fail to submit to mediation as required hereunder, the other party may obtain a court order requiring mediation under section 44.102, Fla. Stat. Any suit or action brought by either party to this Agreement against the other party relating to or arising out of this Agreement must be brought in the appropriate federal or state courts in Collier County, Florida, which courts have sole and exclusive jurisdiction on all such matters. 25. KEY PERSONNEUPROJECT STAFFING: The proposer's personnel and management to be utilized for this project shall be knowledgeable in their areas of expertise. The County reserves the right to perform investigations as may be deemed necessary to insure that competent persons will be utilized in the performance of the contract. Firm shall not change Key Personnel unless the following conditions are met: (1.) Proposed replacements have substantially the same or better qualifications and/ or experience. (2.) that the County is notified in writing as far in advance as possible. Firm shall make commercially reasonable efforts to notify Collier County within seven (7) days of the change. The County retains final approval of proposed replacement personnel. Page 6 of 10 16D9 ..- ~ ._,~. IN WITNESS WHEREOF, the Contractor and the County, have each, respectively, by an authorized person or agent, hereunder set their hands and seals on the date and year first above written. * ~".. BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY, FLORIDA By: ~~ J~~ Donna iala, Chairman , Sunshine Pharmacy, Inc. Lfl First Witness By: De I ~VVI'51 Typed signature and title pvc~ Approved as to form and legal sufficiency: ~tjf? I~L ~iiiitaR.t County Attorney ~,~'ty SL.1/ R. 7i!~~4 Print Name ftem# 11.0 bq Agooda 4111/fa Date ':::.1 Date dl I{)P, Rec'd ~ ~.~ Deputy Clerk Page 7 of IO EXHIBIT A SCOPE OF WORK 16D9 1. Each of the Contractor's pharmacists must possess a current license from the Florida State Board of Pharmacy in accordance with Revised Statutes of the State of Florida, and shall maintain said license in good standing for the duration of the contract. 2. The Contractor shall provide at no additional cost to the County, pharmacy services at locations in areas which are not evacuated during a disaster, and be prepared to accept telephonic requests from the County Emergency Operations Center and fill such requests. Collier County Housing and Human Services Department/Social Services Program will be responsible for the pick-up and delivery of any such prescriptions. 3. The Contractor must be able to fill outpatient prescriptions as needed each day for the duration of the contract within the normal work hours of 8 am to 5 pm. 4. The Contractor shall be able to provide Generic equivalent drugs when one is available to fill the prescriptions. Prescriptions are limited to a 30-day supply. 5. The Contractor shall provide electronic transfer of invoices (billing) to a local PC by-mail at least monthly per Clerk of Court's Finance standards. Such electronic data transfer capability shall be operational within two (2) months of contract start-up and the first billing shall be forthcoming within eight (8) weeks after start up of contract. The Contractor shall provide a contact name and phone number for technical assistance when file format problems arise. 6. The Contractor shall allow Collier County Housing and Human Services Department/Social Services Program direct Internet access to pharmacy data base for client profiles, prior authorizations, overrides, add/ change client information, change eligibility dates and ability to back date ending date, and contact name, telephone number and e-mail address to advise of change of client's social security number. 7. The Contractor shall use File Transfer Protocol (FTP), or other HIP AA compliant compatible programs to transfer encrypted client information (automatically) to pharmacy database at least twice daily, without breaking security. Full file transfer shall be done weekly. Contractor must comply with HIP AA 834 file format. 8. All of the Contractor's pharmacy locations shall be connected on a common network using the same database in order to monitor patient information and manage the formulary. In addition, all locations must be connected to the central system that contains client information. All clients will be given a voucher to provide to the pharmacy. Any physician can write a prescription; this includes Primary Care, specialists, emergency room physicians, dentists, etc. Collier County Housing and Human Services/Social Services will not pay for prescriptions if the client does not present a voucher which shows a valid begin and end date of eligibility. Page 8 of 10 16D9 9. Under the Health Insurance Portability and Accountability Act (HIPAA) of 1996, Contractor is expected to adhere to the same standards as the County and other HIP AA covered entities regarding the protection and non- authorized disclosure of Protected Health Information (PHI). 10. It is highly desirable that the Contract Manager be a pharmacist. The Contract Manager for Sunshine Pharmacy, Inc. will be Del Parrish at telephone number 239-775-6800 and email address sunshinedrug2@aol.com. 11. The Contractor shall identify rebates that are forthcoming and any savings realized from manufacturers' rebates shall be credited against the County's monthly invoice. 12. Payments shall be made in accordance with the Local Government Prompt Payment Act from a joint revolving account for the payment of services provided. 13. The Contractor shall fill all medications to patients for self-administration in accordance with all applicable Federal, State and Local laws. 14. The Contractor shall update and make readily retrievable at any time, all outpatient and drug data within the outpatient profile as each prescription is filled or refilled. The contractor shall automatically monitor drug allergies and interactions according to data available for each patient. 15. The Contractor shall provide monthly Utilization and Administrative reports including number of prescriptions filled, covered individuals, utilizing individuals including physician dispensing profiles and other reports. 16. The Contractor must immediately advise the County whenever abuse, drug seeking or fraudulent behavior is suspected. 17. The Contractor shall provide to the County any manufacturer's no cost, discounted or promotional health care items, which may be provided to them during the period of the contract. 18. The Contractor shall be available for periodic site visits by Collier County staff, to any of their locations, in order to monitor the quality of services provided. 19. The Contractor must respond within twenty-four (24) hours in writing via fax, email or letter, to all questions presented by the Collier County Housing and Human Services Department. 20. The Contractor shall provide outpatient-packaging materials, including labeling, that meets all applicable laws and regulations. Labeling for outpatient packaging shall include: a. Patient Name Page 9 of 10 b. Date of Dispensing Prescription Number Physician's Name Instructions for Patient Use Name and Strength of Drug N umber of Doses Dispensed 1609 c. d. e. f. g. 21. The contractor shall maintain all outpatient drug profiles on a computerized dispersing system. Each outpatient drug profile must include: a. Patient Name b. Address c. Phone d. Birth Date/Social Security Number e. Sex f. Allergies g. Prescription Number Drug data within each outpatient drug profile must include: a. Drug Name b. Drug Strengths c. Amount Ordered d. Amount Dispensed e. Instructions for Use f. Refills Authorized g. Physician Information h. Times and Dates Filled Electronic invoice data must include, but may not be limited to: a. Patient Name (Last, First, MI) b. SSN c. NABP # d. Store # e. RX# f. Date Filled (MM/DD/CCYY) g. Refill h. Physician Name 1. Drug J. NDC # and Description k. Quantity 1. Days Supply m. Generic (Y / N) n. Amount Due o. Billing Date Page 10 of 10 Sunshine . Pharmacy Cost of Services to the County: Exhibit B The fixed prescription-dispensinR fee will be as follows: Brand Name Medications- AWP minus 19% plus $4.50 Generic Medications- AWP minus 30% Sunsblne Pllannll, 5482 Rattlesnake Hammock Rd. Naples, FL 34113 Phone: (239) 775-6800 1400 Gulfshore Blvd. Ste. 100 Naples, FL 34102 Phone: (239) 262-2929 6350 Davis Blvd. Naples, FL 34104 Phone: (239) 775-7207 13020 Livingston Rd, Naples, FL 34105 Phone: (239) 384-5091 80 Wilson Blvd. South Naples, FL 34117 Phone: (239) 775-6800 We are proud to offer the following drugs in 10 day increments at no cost to our patient. Just present your Rx and we will gladly fill it for free. The following drugs are included: . Amoxicillin . Ampicillin . Cephalexin . Penicillinvk . SMZ- TMP . Erythromycin . Ciprofloxacin 16D 16D9 ALLIED PROPERTY AND CASUALTY INS CO ONE NATIONWIDE PLAZA COLUMBUS, OH 43215-2220 '.. p ~APC 5903603950 . 08/15/2008 to 08/15/2009 12:01 A.M. Standard time at the mailing address below SUNSHINE PHARMACY INC BUSINESS AUTO DECLARATIONS 59056 Agency Name: Agency Address: 5482 RATTlESNAKE HAMMOCK RD NAPLES, FL 34113-7454 ACKERMAN INS SERVICES INC NAPLES FL 34109-2110 09 59056-002 006 (239)597-1096 59 Insured is a(n): CORPORATION Operating as a(n): DELIVERS PRESCRIPTION MEDICINE In return for the payment of the premium, and subject to all the terms of this policy, we agree with you to provide the insurance as stated in this policy. ITEM lWO . SCHEDULE OF COVERAGES AND COVERED AUTOS This policy provides only those coverages where a charge is shown in the premium column below. Each of these coverages will apply only to those "autos" shown as covered "autos". "Autos" are shown as covered "autos" for a particular coverage by the entry of one or more of the svmbols from the COVERED AUTO'S section of the Business Auto Coveraae Form next to the name of the coveraae. ~ COVERED AUTOS (Entry of one or more of the LIMIT COVERAGES symbols from the COVERED THE MOST WE WILL PAY FOR ANY ONE PREMIUM AUTOS Section of the Business Auto Coverage Form ACCIDENT OR LOSS :~~~:~~~h a~':oC:: LIABILITY 7 8 9 $ 1,000,000 $ 6,702.00 PERSONAL INJURY PROTECTION 7 Separately stated in each P.I.P. Endorsement $ 563.00 MEDICAL PAYMENTS/EXPENSE 7 $ 5,000 $ 88.00 $ $ UNINSURED MOTORIST 7 " $ 100,000 $ 589.00 BODILY INJURY UNOERINSURED MOTORISTS $ $ $ $ PHYSICAL DAMAGE- 7 $ 495.00 COMPREHENSIVE COVERAGE ACTUAL CASH VALUE, STATED AMOUNT IN ITEM THREE, OR COST OF REPAIR, WHICHEVER IS LESS MINUS THE PHYSICAL DAMAGE - SPECIFIED DEDUCTIBLE IN ITEM THREE FOR EACH COVERED $ CAUSES OF LOSS COVERAGE NAUTO". SEE ITEM FOUR FOR HIRED OR BORROWED "AUTOS". PHYSICAL DAMAGE - 7 $ 1,519.00 COLLISION COVERAGE TOWING AND LABOR 7 $50 for each disablement of a private passenger auto $ 16.00 CARGO LIABILITY SEE VEHICLE SCHEDULE $ MISCELLANEOUS PREMIUM $ Estimated Basic Premium: Estimated Surcharge(s): Estimated Tax(es): Estimated Total Premium: .' $ 9,972.00 $ 99.72 $ $ 10,071.72 " ~*' Countersigned By <> ~ <> <> Authorized Representative EAS176 LKR1 2008256 INSURED COpy ACP BAPC5903603950 912298341 59 fXXXJ777. Date: 11/1812008 10:59 AN! Sender's Fax 10: 16 D 9 ~age2of3 ACORDn CERTIFICATE OF LIABILITY INSURANCE OP 10 GS SUNSH-2 DATE (MM/:C01YYY'O FROOUCER 11/18/08 ONL Y AND CONFERS NO RIGHTS UPON THE CERTFICATE Ackerman Insurance Services HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1575 Pine Ridge Rd, ste. 17 AL TER THE COVERAGE AFFORDED BY THE POUCIES BELOW Naples FL 34109 . Phone: 239-597-1096 Fax: 239-597-9550 'INSURERS AFFORCING COVERAGE i NAIC # liiSuReO-----------------------~------.-----TNSJRER" --N-... Mut..al Fir;;-~-~anc.;'~ L 23779 --- i NSJRER 8 i - -,-------,-- I ~jSlIRE;C , NSURER D Sunshine Pharmacy Inc 5482 Rattlesnake Hammock Road Naples !'L 34113 NSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTOTHE INSURED NAMED ABOVE FOR ThE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREI/EtJT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENTWiTf1 RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SU8JECTTO ALL THE TERMS, EXCLUSIO'JS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE: BE:EN REDUCED BY PAID CLAll~S. LTR NSr:: TYPE OF INSU~ANC!: POLICY NUMBER ['Or;.,~f'(~~If,?!;',E o8J:~CEY ~~~o~Jfil.j LIMITS A , GENERAL LlA31cllY [J COM~1ERCI.AL GENERAL "".slcITY 77-BO-858908 -3001 hi LLAII,I:,. MACA, ~ OC(;I)F: !j -'=-~-===== ! GE~/L AC.GREGATE i_i~i:i }l.PPl ES PER: i ~;-l "()lC" ~ FP,> -: ,-,c I A . ~. I L---l JEcr ,-'--' J AUTOMOBILE LIABILI,",' I I _ ~,., Y AI.;TQ I [-J -"., JW:.iED Al.;T'- S I Ii :>(HEOULEC' AUi(;,::;: J --1 H'KF.'DAiJ7"'JS I ~ N()I.~OW'"E[' 4..'T05 I I . ~I ! I E;;CH OCCURRENCE $ 2,000 1000 11/29/091 ~~CISES(E~to~~r~o',.1 $ 50,000 I MED E~P (Anyon. parsonl ! $ 5 , 000 _ : DERSO"AL &ADY INJ.JR'.' i $ 2 I 000; 000 : GcNERi'i .'\GGRE,,;.Tc 1$ 4, 000,000 '------------y--::----- i PRODUCTS - C)MP/OP AGG ! $ 2 , COO 1000 I 11/29/08 , , COM8INEC, SINCLE LMIT I. j (E~arCI~~~_____._L_---.------ I I ; BODILY iN ..IUR'i i $ I (P~r perscn} I . [--'----------t------ I BODILY NJ.JRY I, (PElracL'lijl?nti i .1> I F'R0PERTY D.t,J,,1AGE I, $ : (PErI' accldentl I ~AGE LIABILITY ~;\h'l',A,lJTn i LE~ESSivMBRELLA LIABIL'TY t: CW.JR LJ CLI;/M.S MAGE L_ 'DEDJC1iGLE ! RETENT!OI'~ f-- I I I i i I ".UTO ONL Y - EA A..::cIDENT r- I' OTH~ lHAN I AUTO ON I.. Y $ EAACC $ $ Ll.,GG EACH O':CURREt,CE $ t",,,::;.P::GA T~_______"__l:!='-,---------:.. I ~ i --- L-------i~'-----.--- I $ , WORKeRS COI~PENSATlCl<AND I E~IPLOYERS' LIASILITY I ~.NY PR<JPRIETQRIPAR,r~ERIE)~(U: I\E OFFCER,MEME<ER EXCliJDEC'" ! I~ y.3S, d&!lcribe Ufl(.ier ' ! S?EC!.AL PROVISIONS be.lcw I i OTHER A ! Property Coveraqe 1 77-BO-828908-3001 11/29/08 ~29/091 DESC~I?TIOI" OF OFE~",TIONS {LOCATIONS /VEHICLES I eXCLUSIONS ADDED BY ENOO~SEMENT I SPECIAc FROVISIONS tThe referenced locations: Sunshine Medical Pharmacy 6350 Oavis Blvd Naples FL 34104 Sunshine Solutions 5480 Rattlesnake Hammock Road Naples FL 34113 S~nshine Pharmacy at Livingston 13020 Livingston Road Naples ~L 34105 l___ci'~tn.1ITi. _.__..______ ______ i EL EACH '\CC IDENT i $ ,--- j I,'=-.L DISEASE- ~n'PL~~_j..~___________ ! :: L DfSEA..<:;E. pOLle'\" ulv!:r $ Contents 700,000 CERTIFICATE HOLDER CANCEL.LATION SHOULD ANY OF THE .~BOVE DESCRIBEO POLICIES BE CANCELLED BEFORE THE EXPiRA":XlN DATE THEREOF, THE iSSUING I,"SURER WILL ENtlEAVOR'-O MAL 30 !;AYS '''-'lITIEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. aUT FAILURE TO 00 SO SHALL IMPOSE NO 08L'G.ATION OR ",ABIL~ OF ANY ~INO UP,)!; THE INSURER, I,S AGENTS OR RE~RESEf.ITATlVES. AUTHORIZED REPRESENTA1'VE Brett A, Ackerman ACORD 25 (2001/08\ <:9 ACORD CORPORAnON 1 Messer I:nsurance Group, I:nc. 1403 Maclay Commerce Drive Tallahassee F.L 32312 Pbone:850-894-8222 Fax:850-894-8228 IISURED - 16D CERTIFICATE OF LIABILITY INSURANCE 'f ~ THIS CERTlRCATE IS ISSUED ~ A MA ONLY AND CONFERS NO RIGHTS UPO HOLDER. THIS CERTIFICATE [IQES NO ALTER THECOVERAGEAFFOI~ INSURERS AFFORDING COVERAGE INSURER A: Landmark Ame:r:ican INSURER B: INSURER C: INSURER D: INSURER E: .1 O"T&~ 10 JO tmSH-1 01/20/09 ITER OF INFORMATION N THE CERTIFICATE T AMEND, EXTEND OR . THE POlICES BELOVIf. NAIC' rns Co. 33138 ~bine Pbaxma 5482 Rattl.anakeCY HaDDOck Rd Naples J'L 34113 COVERAGES CERTlRCATE HOLDER - THE pOUClES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITH!lTANDlNG ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUE[' OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AlL THE TERMS. EXCLUSIONS AND COf\lDITIONS OF SUCH POUCIES- AGGREGATE UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTII 11IM TYPE Of' IIIIURANCII POLICY NUM8ER ~~::~ L..,.. GENERAL UAlllLITY EACH OCCURRENCE $ r-- - COMMERCIAL GENERAL LIABILITY PREMISES (Ea ~;;;'1CII1 S I-- tJ ClAIMS MADE 0 OCCUR ~~D EXP (Anyone penon) $ ,...-- PERSONAl & AnV INJURY S '--- ~5NERALAGGREGATE s rrAGG~rr;:: APnS PER; PRODUCTS .. COMPIOP AGG $ POLICY JECT LOC ~TOIIOIIlLE UARITY COMBINED !lINGlE LIMIT S ANY AUTO lea ac:ddentl I-- c...- AlL OWNED AUTOS BODILY INJIJRY SCHEDULED AUTOS (Plr person) S - I-- HIRED AUTOS BODILY INJlJIRY NON-oWNED AUTOS (Per occidenl) S r-- I-- PROPERTY DAMAGE S (Per accident' GAIlAO& UMILITY I AUTO ONlY - EA ACCIDENT S R ANY AUTO OTHER THAlli EA ACC S AUTO ONLY: AGG S 1!XC1lS81 UMIItEUA UA.LITY EACH OCCURRENCE S tJ OCCUR 0 CLAIMS MADE AGGREGATE S S R OEDUCTIBLE S RETENTION S S WORKERS CCliMl'BJIMTION ITORY"LIMrrS I IOJ~ oUID IIII"LOYIRS' LIA8IUTY Y/N ANY PROPRIETORlPARTNERlEXECUTIVD E.L. EACH ACCIDENT S OFFICERlMEMBER EXCLUDED? (1Iand1llllNJ III NHI E.L. DISEASE. EA EMPLOYEE S ~Mt.ii'klleOVlS~~S lleIow E.L. DISEAse. POLICY LIMIT S 011tl!ft A Professional. LHM'717476 05/01/08 05/01/09 Eeh Claim 2,000,000 LiabUi tv Aqqreqate 2.000.000 DEllCIUI'TlON Of' OI'EftATlONa I LOCATION' I vmtICU!S IIIXCLUIIONS ADDI!D !IV END0ft8EMENT I SPECIAL "RO\IlIIONS CANCELLATION SHOULD AlfY OF l1ll! AElOVI DElCIltBl!D POLICIES 8& CANCEU.ED IIEFOftE THE Dl'lRATtON FORPR-l IIATE THIlREOl". THE ..UINO lNlIURIlR WILL ENOIIAVOR TO MAIL -0- DAYS WRI'TTD NO'I'IC&: TO THE CI!ImFlCATE HOLDER NAIII!D TO THE lEFT, IIUT I'AlLUIlE TO DO so SHALL .I'OSE NO O8l.IGATION OR UAlllLITY 01' AlfY IOlUl UPON THE INaU-,1Ta AO&N'TS Ol't RIlPR5lIUITA R! For Proposal ACORD 25 (2009101) The ACORD name and logo are re 16D9 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED. subject to the tenns 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). DISCLAIMER This CertifICate of Insurance does not constitute a contract between the issuing insurer(s). authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2009101) 81/15/B9 17:12:29 GUARD 578-825-9988 -) 239-919-54% ]6D Page 881 9 f............................................................................................ ..SU..R... :.:.:.:...:.:.A..::::" .0. ...... . -, ... . . " - .. . . . '.. '.. . . .... ..... ..... .. .... . . . . . . . . ..-.- ... . ... . . :. :.:::.J.N. ...S...U..R.. A:..:.N.C. ....e.. . ".- ... ... .. ... .... . .. .:..8.... ..R.:.O..:.U. P . ...... . . .. ..... ... . 0... ... ... .. . ..... ........" . ...... ... "'. . ... . . . . .. . -..... .... ....... . . ...,.. - .'. . ,. . ..... - . . ... ._--.. ...... .. . ... .. ...................................... . ........... - . . . .. . , . ... ........-_..-....... . . Workers' Comoensation and Emolover's Liability Policv: NorGUARD Insurance Company - A Stock Company Policy Number SUWC914328 Renewal of SUWC808393 NCCI No.[25844] [1] Poli Named Insured and Mailing Address SUNSHINE PHARMACY INC 5482 Rattlesnake Hammock Rd Naples, FL 34113 Federal Employer's ID 59-3518172 Information Pa e Agency PAYCHEX AGENCY, INC. 150 Sawgrass Drive Rochester, NY 14620 Agency Code: NYPAYC10 Insured is Corporation ..------.--------.----.--.-.------------.------.-.---j i [2] Policy Period ! I From March 18, 2008 to March 18, 2009,12:01 AM, standard time at the insured's mailing address. ! r~,..." "... .diU U _.......UIIIIII!UIIiIll'_ _............__________ 11I'1__ "__IIIlIlllllIMII__"'___.__.<I.I>. .......~_,.II.'" ........I_J.lll _......11II'"''''............1 _.......lIlIl&.~IIIlJ...,." MIlII'1 ""11I...."'1 I ['3] ~ I I I I ! I ~ I C. Other States Insurance - Part Three of this policy applies to all states, except any state listed in i i item [3]A. and the states of North Dakota, Ohio, Washington, West Virginia, and Wyoming. ! ! D. This policy includes these endorsements and schedules: ,i I See Extension of Information Page - Schedule of Forms l',,,,,.,''''''''''''''''''',..'''_''''.........,...,''''''''''''''''''''''''''''''....--..-'''''''''''''''~'''''''''''''''_~.......................,...........,''''''''''''"''.......'''''''''''''''''''''''''''~....'''''''''''''''..................___''''''''_''''..'''''""""...,.....,""""""""""""""'_:",.."::,,""''''''''',............''''.......,......,'''''''''''''''_'''''''''''''''''''"....~''''_..,,,,''''.........''''''''''''''''''''''''''''''...._ Coverage A. Workers' Compensation Insurance - Part One of this policy applies to the Workers' Compensation Law of the following states: Florida B. Employer's Liability Insurance - Part Two of this policy applies to work in each of the states listed in item [3]A. The limits of our liability under Part Two are: Bodily Injury by Accident - each accident $100,000 Bodily Injury by Disease - each employee $100,000 Bodily Injury by Disease - policy limit $500,000 1-[-4]-....P~;-;;:.ium --..-.-------.--.--------.--.----_.~--.-.....--......------------.-------.--1 i The Premium Basis and, therefore, the premium will be determined by our Manual of Rules, i I Classifications, Rates, and Rating Plans. All required information is subject to verification and change i ! by audit. (Continued on another page) ! 1......--------- ---------------------_____..J Total Estimated Policy Premium Total Surcharges/Assessments Total Estimated Cost $ $ $ 10,725 o 10,725 pag e - 1 - Information Page we 00000lA INTERNAL USE XX MGA : SUWC914328 Da~ : 02/17/2008 16 South River Street - P.O. Box A-H- Wilkes-Barre, PA 18703-0020 _ www.guard.com 81/15/B9 17:13:21 GUARD 578-825-9988 -} Pdoei6D9 Workers' Compensation and Emplover's Liability Policv NorGUARD Insurance Company - A Stock Company Policy Number SUWC914328 RenewalofSUWC808393 NCCI No.[25844] 239-919-54% f................................... ....9..U....I.... . . . . . .... . ... . . . -. .... . " '.' .." . - .. . . ...... ... . . . ..... -. .. ... ... . ,.... .. . ... .. .. ., .... . . ........AD . ....,......,.. --.-,--......... ... . - . . :. :.........:1. NS..U' R. A' :N..C.......E.. . ... .. . . .. . .... ... ... .. ..... ... . .. . .. .... .-..... .... .. ....... .. ...... "' ... .... ... , .. . -. ...........:.....:.:.:.G.:.:.:...:R.:. :(]):::. .u.:. P.:..:: . ." . .. . . . ....... .... ....... . ., . . ... . " .. , .. .. . .. .. . ....-. -..... .. .. ..-.............., ..... ". . , .. . , . . . . , . . , . . . . . . ....._---,,--.-........................, Policy Information Page Extension of Information Page Schedule of Forms WC 000404 - PENDING RATE CHANGE ENDORSEMENT WC 000414 - NOTIFICATION OF CHANGE IN OWNERSHIP ENDT WC 000406A - PREMIUM DISCOUNT ENDORSEMENT WC 000308 - PARTNERS, OFFICERS & OTHERS EXCL. END. WC 090402 - FL EXPERIENCE RATING MOD. FACTOR ENDT. WC 090606 - FL EMPLOYMENT AND WAGE INFO. RELEASE ENDT WC 990008 - FL ADDENDUM WC 090403A - FL TERR RISK INS PROG REAUTH. ACT END'T WC 000001A - INFORMATION PAGE WC OOOOOOA - STANDARD POLICY WC 000419 - PREMIUM DUE DATE ENDORSEMENT INTERNAL USE XX MGA : SUWC914328 Date : 02/17/2008 pag e - 2 - Information Page we 00000lA 16 South River Street. P.O. Box A-H. Wilkes-Barre, PA 18703-0020. www.guard.com 04/14/2009 16:39 2395303750 9lLUTIOfE PAEI': L 6 0 9 Work~.J:S' Comp.,e.osation and EmP-1oye.r's LiabUjty PoJie)': NorGUARD Insur:ance Company - A Stock Company PolicV Number SUWC021076 R:.enewal of SUWC914328 NeCI No.[25844] fGUA:Rl0 INSURAN(~E . GROU'P policy Information Page [1] Named Insured and Mailing Address SUNSHINE PHARMACY INC 5482 R.attlesnake Hammock Rd Naples, FL 34:l13 Federal Emplloyer's 10 59.3518172 Agency PAYCHEX AGENCY, INC. 150 Sawgrass Drive Rochester, NY 14620 Agency Code: NYPAVC 10 Insured is Corporation [2] Policy perioel From March iE, 2009 to ~larch 18, 2010. 1.2:01 AM, standard time at the insured's mailing address. [3] Coverage A. Workers' Compensation Insuranc::e - Part One of this polley applies to the Workers' Compensation Law of the following !;tates: 'Florida 6- Employer's Liability IFlsurance - Part Two of this policy applies to work in each of the states listed in item [3]A. The limits of our liability under Part Two are: Bo::lily Injury I)y Accident - eaCh accident $100,000 Bodily Injury 'JY Disease - each employee $100,000 Bodily Injury by Disease - policy limit $5DO,000 C. Other StClI;es Insurance - Part Three of this policy applies to all states, except any state listed in item [3]A. and the states of North Dakota, Ohio, Washington, and Wyoming. D. This polic~' includes these endorsements and schedules: See Extension o~ Information Page - SChedule of Forms [4] Premium The Premium Basis and, ~herefore, the premium will be determined by our Manual of Rules, Classifications, Rates, and Rating Plans. All required information is subject to verification and change by audit. (Continued on another page) rTot;I-E;i;~;;d"'p;II~;";"'p';;~i~;;-'!~~~~"'.""~'~''~-'~'~I'~"'-'$~'~"~r~'~~'~'~I"I~~f":;N;:';~~"_':\'~I.?..~.~,.._.""",......~I"~".'~_(~'."~~~~~'_~"11W1~'~'~'l"~'~"-~'."""-'---l ~ Totar Surcharges! A!ISeSsmentli $ 0 . f i~~~!,~r::.~~,:,~,~~~".~~.~f:_~..,~,~~.~",."._.~ "".~ v>".",",,,...,.~,.~,,,,,"!.," .".....',.., ...".~ .~,~,~.!3.>,."".".""~."..,.,,,-,~,.. ,..~,..,_.,....".~'",... "'''''.'~'""''''''''.'~'''-__''''''_'.'_M'V",._J INTERNAL."U_S_E~ page ~ 1 . f . MGA; SUWC021.076 ' rr'1 orm..tlon p<lge D~te : 02/16/2005) we OOOOOlA 16 Soutt, River Street. P,O. Box A-H. Wilkes-Barre, PA 18703-0020. www.guard.com 04/14/2009 16:39 2395303750 SOLunm1S 16.D a · PAGE 03 Workers' Com~nsa~JJn 8!}.d EmP'loyer~ - - NorGUARD Insurance Comp.imy - A Stock Company Policy Number SUWC021076 Renewal of SUWC914328 NCCI No.[25844] Ji GUARI) l' ~lf6'UC~ Policy Information Page Extension of Information Page Sdtedule of Fc.rm$ .. WC 000404 - PENDING RATE CHANGE ENDORSEMENT .. WC 000414 - NOTIFICI~TION OF CHANGE IN OWNERSHIP ENDT WC 0004061\ - PR.EMIUM DiSCOUNT ENDORSEMENT WC 000308 ~ PARTNERS, OFFICERS & OTHERS EXCL. END. .. we 090402 - FL EXPERIENCE RATING MOD. FACTOR ENDT. '" we 090606. FL EMPLOYMENT AND WAGE INFO.RELEASE ENDT WC 990008 - FL ADDENDUM .. we 090403A - FL TERF. RISK INS PROG R.EAUTH. ACT END'T we OOOOOtA - INFORJI.IATION PAGE we QOOOOGA - STAND.:l,RD POLICY .. we 00041S - PREMIU~' DUE DATE ENDORSEMENT * As part of GUARD's ongoing commitment to environmental responsibility throughout our operations, we hillve ChOSE!n not to rE,print those forms (marked with an asterisk) that have not changed and were previously sert to you- You can obtain a new copy of any of these forms by accessing your account information at GUARD's Policyholder Service Center (a selection available via our website at www...guard.cClm). Pleast~ be aware that you will be asked to enter your po1iel{ number, policy inception date, and federal ID number in order to log on to this secure portion of our site. Alternatively, you Cilln Co ,tact us via phone at :1.-800-673-2465; our Customer Service Representatives will either be ,~ble to help you locate a document yourself or can send a copy to you. As always, we thank you for selecting GUARD 8S your insurer. We look forward to serving Y':Ju! UHERNAI lIS~ MGA , SUWC021076 Date : 02/1612009 I"<lge . :<! - tnformation page we OOOOOlA 16 South River Stre,~t. P.O. Box A.H. Wilkes-Barre, PA 18703-0020. www.guard.com 04/14/2009 15:39 2395303750 SOLUTIONS PAG1 it 9 59056 ......'1,: ", ~, ,,1,' ". . . . ''';,n,,:H,:' , ..,' ..'..~,r t ~- ALl..:J:EO I'ttOPER'TY Ate CASUALlY INS CD , . ~l NA1'tONllJ:DE PLAZA //.'i(i';~ .......... _. ... .....-222. ...:-.ri51.2008 to CN!i/1512009 1:!:01 A.M- Standard time at the mailing address below . fed: SUNSHINE PHARMACY INC BUSINESS AUTO DECLARATIONS \. .~: .'T.,'.... . ~:'" Agency Name: A.gene;y Address: 5482 RATTU:SNAKE ttAlMMOCK RD NAPLES, FL 34113-7454 ACKERMAN INS SERVIC:ES IHe NAPLES FL 341",,2110 ':. . ~i' -, 09 59MB 002 006 (239)597-1096 69 i. r. i , Insured is a(n): CORPORATION Operating as a(n): DEUVERS PRESCRIPTION MEDICINE In return fOr the payment of the premium. ana sUbject to a I tne te~ms of t"'is policy. we agree with you to provide th;= in$ura...ce as stated in this pol,icy. 1'1'!M TWO . SCHEDULE OF CO'IIRAG'ES ANI) COVERED AUTOS This policy provides only those coverages where a charge is shown in the premium column bela\\', Each of these coverages will apply only to those .autos' shown as covered ~aul05H. . AutoS" afl~ shown as covered Hautos. for at particular coverage by the entry of Qne or more of the s s ~ m e CO"" RED AUTO'S se!:tion of the Business Auto covera e For next to the n me t covel'a e ~RI;D A~ITO:;; :Entry __ ",,!nO'W aftlle LIMIT COVERAGES ,iYTntia11I lOlI'" .. c~m THE MOST WE WILL PAY FOR ANY ONE PREMIUM ~_~.:.o;:~~,::~ ~,,::r:~ ACCIDE.NT OR LOSS UP.BIUiY 7 8 9 $ 1,000,000 $ 6.102.00 PERSONAL 1NJUIW PROTeCTION 7 5eperate\y st8tt!lc:l in 8lIC/'1 P.I.P. EnClorsement $ 563.00 MEClCAI. PAVIoAENT5IEXPENSE 7 $ 5..000 S 88.00 S s - . UNIH~URI!:C MOTORIST 7 , $ 100..000 s 589.00 1lQOIL"I' IN.IUAY UNQER1NSURED MOTORISTS S $ s Ii PHySICAL DAMAGe . 1 $ ""S.OD OOMPRB1ENSIVE COVERAGE ACTUAL cASH VALue, STATED AMOUNT IN liEU THREE:, OR COST OF REPAIR, WHICHEVER 15 LESS MINUS THE pHYSICAl. DAMAGE' SPECIFIE[;' DEDUCTlal..~ IN ITEM THREi FOR EACH Covl:REO $ C,AUSES OF !.CSS COVe:RAGE "AUTO". SEE ITEM FOouR FOR HIRED oR aORROWED PHYSICAl. OAMAGE - "AUTOS", COLLISION COVERAGE 7 S 1.519.00 TOWING AND LABOR 7 550 10r ucl'1l1111lllblenl"nt of a prlviMe p.$flSenger llIuto Ii 16.00 cARGO UA811.1TV SEE ViHIC\..E SCHEDULE S MiSCeLlANEOUS PREMIUM $ , .[ Estimated Basic Premium: Estimated Surcharge(s): Estimated Tax(es): Estimated Total Premium: ~, 1 ",'t $ 9,972.00 $ 99.72 $ $ 10,071.72 ~ := 'i. COuntersigned By - t Autl\arized i;!epresentativ6 8 EAS11$ . LlCR1 --- INSURED coPy ACP BAPC"'~ 9122883C1 .. OOIIITITI 04/14/2009 15:39 2395303750 SOLUTIONS P3QIl2013 l".J'd~t:'."'" I_"'"'UV'.... ......-..... PAGE 15 - - 6D 9 From:Tablths M Nlcat;O FsxlD: ACORD~ CEHTIFICATE OF LIABILITY INSURANCE oP,e TN I !lATE If,lMIDDlYYV'I'l SUR:;IS-2 Q4/14/09 PRODU(:F.R THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO~ ONLY AND CONFERS NO RIGtHS UPON THE CERnFICATE AOke~ Xn~uranoe se~~OQG HOl..DER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1575 P~~~ ~dge Rd. S~. ~7 .ALTER THE COVERAGE AFFORDED BY THE POLICIES BeLOW Naples FL 34109 NAIC# Phone: 239-S97-109E, ~a:ll: :239,.597-9560 INSURERS A.FFORD1NG COVERAGE': INSURE() IN!';URIORA; "" Mo._~ :rix.; Ift5ur...-. c::o. 23779 1H5~IRF.R E1~ Sunshine l'h~oy :l:r,c N$VFlf.~ c: 5482 ~ttlB$~ake RaDcock ROl'.d INSURER 0: Nap1.c51 FL ;:14113 INS~E.R": TME POUCles 01' INSuRANCli USTEO BELOW HAW Illl.EN IssuED TO I totE INSURED N""MED ABOVE FOR lPIl;; ~OLICV PERIOD 1~':IDIC...Tm. NOlWlTHSTANDING ANY REQUIREMENT, TERM OR CONCmON OF ANY CONTRACT OR OlllER COCuMENT WITH RESPECT TO WHIOH nUs OERTlFICATE. MAY BE ISSUED Of! MAY I"EA.TAN. THE INSURAN'~E ,6,FFoImED B" iHE. POI.ICIES DESCRIElED HEREIN IS .s\JBJECTiO ALL THE TERMS, EXCI.U$ION'~ ANO CONDITIONS of SUCH POLICIES, AOC!JREGATE LIMITS SHOWN MAY I-AVE i:lEEN l'l:EDUCEO BY PAlO ClAIMS. lMM AO~~ poLICY NUMIiI~A "&~T~E I'W,~N UMlTtl !.TIlINS TYPE OF INSU ~At<<:E ~~RAL LlAIlLTTY EACH OCCIJRRENCF. s2 000,000 A X ~ COMMERCIA/.. QlO~ mAl. L.IABILlTY "7-BO-858909 -3001 11/29/09 11/'),9/09 ~~s'~';"~~_ ~Q.,OOO._ f-- - e-- CLAI...!! MAO&, ~ occu~ ~"D!;'xP(~ny""o_1 $ 5 , 000 -.... -,--"- ~~INJUR~_ 1'o2,OOO.O~L ~~tOQilEGlA.TE s 4 ,000 000 GEl\. AGGfli~"'i L11v IT APPL.IEj p~: PAooucr:~ . eo~PIOP ....GQ l :2 ,000.000 X PRI). I POLICY JE(:1 lOC ~MO~LE LIABILrTf COMBIN'CD SIN';;!.!; LIMIT J AIoIV AUTO {E'_~"'l - -- - Al.I. OWNF.O i\UTC'5 BOOIL.Y I~.JURV SC~IEtlIJLEC AUT,)!; {~"'PO"'OIl) $ -- HIREO AUT05 IlOIJIL V I~,JURY NOIH)WNEO ^UlDS (p.r oooioonl) " - -' r_' - PROPERTV llAMN;. " {PO' 8..1",,01) GAiBE UABILITY AUTO <l:>! . V . EI\ A(.CIDENT $ mY AUTO O':'H'CR TIV,1'oI ~AJ:C $ AUTOONI.Y: AClL'i $ EXCESSJUMBRELLA l.IAlllUTY F-IIOH OC.C\.IIlRF-I'oICI; $ ~ OC;CUO:: LJ CLAIMS MAllIS AMROG,\TE $ ~_. ~ _I tJEDUCTlIlL. s RE'rENTION ~ S WORKEIlS COMP!!fl$I\TlOf< AND Tn~'tlatr~ I Il>d~- EMP~OYEA$' LIAIlLITY NoIY pnOl>~F-TOFlIP^~ThI(H~:':EOUfIVE E.L. EPt:>1 "CCICENT $ o~~ICERIM'E""8Ef'. l'.xOLLlCEC1 E.L.. DlSEIISE-EIIEMPL.l;IYEE S ~~Edl1t~~~1oN~ ~ICN' E.L. t'lISeA!ilE. POLICY L.IMIT S OTl'lER A Pxoperty coverage 77-80-82890$-3001 11/29/06 11/29/09 C:ont;ents 700,000 DESCfllP'TlCN O~ QPERATlI;lNB f LOCA"ONS' VEHlI.l.ES I EX<:~UlIIIJNS ADDED IlY eIIDOIU;EMEIIIT I SPECIAL PROVI!lION' ~.~l~asa note o~rtif~c~be holde~ 18 also listed as Addi~~ona1 Insured"'''' The coverad locations ;llJ,c:_ uded. oIl.;l:e' Sunshina NGdlcal Pharnacy 6350 Dav~s Dlv~ NaplQs FL 34104 Sunshine Solutions 5~80 ]ULt~esnake HammPck Rd Naples FL 34113 SUnsh:l..ne PharlllQc.y at Liviaqston 13020 Livinqaton Rd Ii eo Wilson Blvd S. ~ - SHI;lUI,D ANY OF Till; ABOVE DE5CRlllED I'Ol1CIEll Ill> CANCELLED lJBFORE fIlE EXPIRATION DATE "'H~EOf. T1tE ISSUING Itl$URER WILL ENDEAYOIl TO MAlL ~ DAYS WftITTEM Collier count.y BQ~\rd of COWlty NancE 1'(> THE CElUIF1CATE HOlOEfl flIAMED TO THE L~. RUT FAILURE TO DO SO SMAL~ Commi.sion4!'!%s IMPOSE 1olO OB~"ON OR LljUillUTV OF ANY KIN1;I1J~ON THE INS~ER, ItS AGI!NTS OR 3301 :J!:. Tamiami 'l:3:8,:i1 REPIlES6fITATrvE', Naples FL 34212 AUT1lORIZEtl _"esatTAfM! ACORD 2S ~OO1i08 Br~t:.t A. Acke=ma.n @ ACORD CORPORATION 1 coveRA.GES CERTIFICATE t40LDEI~ CANCELLATION 16D9 T, .iTIFICATE OF LIABILITY INSURANCE .....: :t_VIUlCla 8lro\Ip, :tIKI . 1403 lI&C1ay ~ Ds-i... 'h1.~." 1'10 32S12 ~:a50-".-8222 "'~850.894-8228 IIl8l.IItfiD 1!!~""~~Gk led "SURI!RS AJ'I'ORDING OOVIItAGE 1M6U1liRA: k ~3.gAA %IW ~. INlMa!fIlJ; IIIISURE.. c, lllGOIiER l): IBJREA &; NAIC t n1l8 COVERAGES TI1! POLJCllIi& Of lNallUHll LIITJIllELOWtlAV! III!EN I&Q,IIIP TO nlI 1N8UI'ED NAMI!OA8OIIIFQIII nili POLICY PEIlIOllINlllCATIiD. NDTWmI&TANOIHG AN'i ~T, TERM OR OONOITlQN Of Nty CONTRACT OR OTHER DClCu....' WITIoI....I'1eT TO WHICH TI'tI8 CiFITIPJC.-.TI MAY IIli IBlIUEtI 011 WAY I'IRT~, '1ME 1tGUIWIC~ .flFPORDID 8'l'TI1E POLI(:IU DltCRIIED HIflElH IS lUe.lECT TO ~ THlI Tl:RMB, EXCWSlONlj A/oIg CONDiTiONS 01" auCIol POIJIllIi., AGCIIIMATIi ~"TIIIMO'WlIN MAY ""VI alEN R8)~ IV PAlO Cl.AlU$. 'M'IlOPII"IIlAIl!!E IOQLICW"-' ....... LlAIIlLl1'V coWEllCw. GENiJW. LIAIIIUlY C~11WlE 0 OCCUR LIMITa . . . , I ,., . , \lOMBINED SlNGl-ILlMIT [Ea-.n) lIODl~V IN.lUIn' IPorP\ll'lllln) . I!ODIL Y INJURY lP.tlllCi:illorJCl PRQPIiJl'N ClAMI\GIii [N' ICDllIl'lll GNWIII.NIl./I'Y AItt oWTO W~1'& ...ufO QN~ Y - EA ACClCEN'I' . e...ACC . AC3G I I S EACH ggQUAR~ AGGRliQATli DICl""lIIIlIIllIU.A ~LIrT OCCUR 0 cLAIMS ......DB ClIOUCTI~ RSnDITION . . I I . . I A LIDI'Ii.'J4'76 05/01/09 05/01/10 8ch Cl&.1& .t:.e 2,OQO,OOO 2 000 0 D n:l.' II 0'8- 512..g P~4r~Q,.Cj Sqvlcc..S' IV ill .TI~~ CQ:L.IIXIlB eANCliL.l.Al1ON IHDUIJ)MV 0I''I1lD ~...-m I'Q\.ICID Be CAlIR&.UD.-oM lMli IlCflIlATION u.ATI ntellIiOl', ". IMUIIIG"'-""'" pDU._ TO..... lL- 1llI\'V'I..-rlWK 1lO'lIClII1O '111. CIIIft'IlZATIl NOlJIIiR lCMliO TO ~ ...,.. lIlT IWL\lM TO DC! 110......... IfO CIIUIaA'nClfIO.~ 0# MY _ W'Off TIIf: -.naMlIIIft 01' ~'nWIIlS. IIlTATNE camFIOATl! HCL.I:leR Co11u&' Coml~ Bee 3301 . 'hmitlllli 'ftul ~. I'L 3.112 ACOIW U(2OCIIlO1) tIil 3~\;;ld SNOI1.rrDS 6PBS616 Bl:Pl 6BBl/BE/PB lliI UUU.U "\lU~ 16D9 IMPORTANT If the oertifk;ate holder is an ADDITIONAl INSURED, me policy(iee) must be endorsed. A Aatement on this Ci8rt1ficatl don not confer rights to the certificate holder in 11eu of $Uch endorwment(s). If SUBROGATION IS WAIVED. subject to the terms and conditions of the policy, certain polcies may require an endonMll'Mnt. A -.tement on this certificate does not confer rights to tI"le certifloate holder In Iiw Of such endon5ement(s). DISCLAIMER This Certificate of In&Uranc8 doel!l not conatitutB a contract betwHn the iauing insurer(e). authClriud representative or produc::er, and the QIlMtItIcate helder, nor do" it affirmatively or negatIvelY amend, extend or lllter the coverage afforded bJ!the poli0ie8listed thet'eon. It.CO 211 (2101101) Z0 39'i1d SNOLLnlOS 6t'096t6 0Z:t't 600Z/0E/t'0