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CERTIFICATE OF COVERAGE Certificate Holder FLORIDA DEPARTMENT OF HEALTH EMERGENCY MEDICAL SERVICES 4052 BALD CYPRESS WAY, BIN C-30 TALLAHASSEE FL 323994738 Administrator Issue Date 2/27/ Florida League of Cities, Inc. Department of Insurance and Financial Services P.O. Box 530065 Orlando, Florida 32853-0065 14 COVERAGESTERM OR CONDEMN OF ANY TMs 5 TO CERTIFY THAT TIE ACRE M3IT BELOW HAS BEUEGN N ISS) TO TIE DBIATED FBBER FOR TIE COVERAGE PERIOD INDICATED. NOM ITHSTNEH NG ANY REQUre@E0T, CONTRACT DR O1/E2 DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE COVERAGE ArTORDED BY TIE AGRHEMBJT DESCRIBED HEREIN 15 SUBECT TO ALL THE TERMS EXCUSIONS AND CONDITIONS OF SUOI AGREEMENT COVERAGE PROVIDED BY: FLORIDA MUNICIPAL INSURANCE TRUST AGREEMENT NUMBER: FMIT 0274 COVERAGE PERIOD: FROM 10/1/13 COVERAGE PERIOD: TO 10/1/14 12:01 AM STANDARD TIME TYPE OF COVERAGE - LIABILITY General Liability ❑ Comprehensive General Liability, Bodily Injury, Property Damage and Personal Injury O Errors and Omissions Liability ❑ Supplemental Employment Practice O Employee Benefits Program Administration Liability ❑ Medical Attendants/Medical Directors Malpractice Liability ❑ Broad Form Property Damage O Law Enforcement Liability ❑ Underground, Explosion & Collapse Hazard Limits of Liability Automobile Liability ® All owned Autos (Private Passenger) ® All owned Autos (Other than Private Passenger) ® Hired Autos ® Non -Owned Autos Limits of Liability * Combined Single Limit Deductible N/A TYPE OF COVERAGE - PROPERTY ❑ Buildings ❑ Bask Form ❑ Special Form ❑ Personal Property ❑ Basic Form ❑ Special Form ❑ Agreed Amount ❑ Deductible N/A ❑ Coinsurance N/A ❑ Blanket ❑ Specific O Replacement Cost ❑ Actual Cash Value ❑ Miscellaneous O Inland Marine ❑ Electronic Data Processing ❑ Bond Limits of Liability on File with Administrator TYPE OF COVERAGE - WORKERS COMPENSATION ❑ Statutory Workers Compensation ▪ Employers Liability ❑ Deductible N/A ❑ SIR Deductible N/A $1,000,000 Each Accident $1,000,000 By Disease $1,000,000 Aggregate By Disease Automobile/Equipment - Deductible ® Physical Damage $1,000 - Comprehensive - Auto $1,000 - Collision - Auto NA - Miscellaneous Equipment Other • The limit of liability is $200,000 Bodily Injury and/or Property Damage per person or $300,000 Bodily Injury and/or Property Damage per occurrence. These spedfic limits of liability are increased to $5,003,000 for Automobile Liability (combined single limit) per occurrence, solely for any liability resulting from entry of a claims bill pursuant to Section 768.28 (5) Florida Statutes or liability/settlement for which no claims bill has been filed or liability imposed pursuant to Federal Law or actions outside the State of Florida. Description of Operations/Locations/Vehicles/Special Items RE: Insurance Coverage Verification THIS CERTIFICATE S ISSUED A5 A MATTER OF DECIMATION ONLY MD CCNIFSIS ND RIONTS UPON THE CERTIFICATE FICADER. THS CERTIFICATE DOCS NOT MED. EXTBD OR ALTER TIE COVERAGE - • • N:. BY 11E AGREEMENT ABOVE Designated Member TOWN OF INDIAN RIVER SHORES 6001 NORTH HWY A1A INDIAN RIVER SHORES FL 32963 Cancellations SMOLLD ANY PMT OF TIE ABOVE QO2®® ACREMENT BE CANCELED BEFORE THE ECPBGTION DATE THEREOF, TIE ISSUING COMPANY WILL ENDEAVOR TO NAIL 95 DAYS WRITTEN NOTICE TO CERTIFICATE WATER R NME) ABOVE, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY IOND UPON THE PROGRAM, 115 /CENTS OR R6NBBNATNES. AUIHORI2133 RERBBATIVE EMR -CERT (9/2110)