CERTIFICATE OF INSURANCE (3)
ALL CHILDREN'S HEALTH SYSTEM, INC.
801 6TH STREET SOUTH
. ST PETERSBURG, FL 33701 .
CI!RTlFICAT& NUNlIl!R
11954 .
THIS ClRTlPlCATE II ISSUED AS A MATT!R O~ INFOItMA710N ONLY AND CONP!RS
NO RIGHTS UPON THE C&ItTlI'tc:AT! HOLliER OTN&R THAN THOSE! PROVIDeD IN .THE!
PQUCY. THI. CER71F1CAT1! DON NOT AMENll, &XTEND OR ALTER THIi COVI!MOl!
APJlORDl!O BY THE POUCIES DNCRIBIIl HEREIN.
COMPANIES AFFORDING COVERAGE
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COMPANy
B STEADFAST INSURANCE COMPANY
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; COMPANY
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PRODUC!;!R
. Marsh
3031 N. Rocky Point Drive, Suije 700
Tempa FL 33607
Attn: 813.207-5100
'INSURliD
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COMPANY
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THIS IS TO CERTIFY lliAT POLICIES OF INSURANCE DESCRI8&D HiRilN HAVE BEeN ISSUE:D TO THIS INSURED ~eD HIlRelN FOR TH& POLICY Pl!RIOD INDICATeD.
NO'l\\llTHSfANDING IWY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT IMTH ReSPIiCT TO \I\tlICH THE CERTIFICATe MAY BE ISSUED OR MAY
PERTAIN, THe INSURANCE AFFO~DeD BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONOITIONS AND EXCLUSIONS OF 8UCH POLICIES. AGGREGATE
LIMITS SHOWN MAV HAVE BEEN RiDUCED BY PAID CLAIMS,
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OENI!IW. LIA8IUTY d~J.!l'-Il~\..I\CJ.~~!'.~!i.... __.~..~ ...._..... . . _. ....__. ._
.... 'i COMllllliRCIAL GENERAL LIABILln' PRODUCTS _ COMPIOP AGO I $
'j!jj . .:'; CLAIMS MADe. !........I OCCUR ~~;~~";';-~-;';N~~~;'--' .S........ . H'" -.... .--.
OWNER'8&. CONTRACTOR'S PROT ;CH' oce~~R~~~~--' ..- '$- . .... ....-. .....-... ...
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, MED Exp on. ragn ~ $
f~~"-':"-- ;-- _1.000.000
(Pet peraon)
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BODILY INJURY
(Per looJclent)
810.1113A350Tlla05
12/16/08
12116106
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AUTOMOBlLli.UABlUrr
1< ~ I ANV AUTO
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~. _.' SCHEDULED AUTOS
: HIRED AUTOS
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~..... NON-OWNED AUTOS
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$
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PROP&Rn' DAMAGE
B
E)(CIl88 UABlUTV
HPC8917678-00
! 12/15105
/12/11!1/:
1$
AUTO ONL v - EA ACCII)ENT $
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AGGREGATE . $
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: GARAGE UABlUlY
.. :! ANY AUTO
.. UMBREL.LA FORM
X OTHER THAN UMBRELLA FOIllM
N~TlON
eMPLOV!RS' UAIlU'I'r
THE PROPRIETOR/
. PARTNERS/exeCUTIVE
OFFiceRS ARe:
INCL.
EXCl
V LIMITS I E
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eL DISeASE-POLICV LIMIT $
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EL DISEASi-eACH eMPLOYEe: $
DESCRIPTION OP OPIRATICN8ILOCATlONalV!HICLE8l8PiClAL.ITl!MS
GENERAL LIABILITY SUBJECT TO 51.J..000,OOO1$2,ooO,ooO SIR. PROFESSIONAL LIABILITY SUBJECT TO $3,000,0001$10.000,000 SIR. THESE ARE
POLICY LIMITS AND NOT APPLIED Tv INDIVIDUAL STAFF MEMBERS.
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SHOuLD At<< OF 'nolI ~1C1l!8 D~I_ HIII!lN el! eANC5LI.EO III'OAI! THE axlllRATlON OATI! TH~",
'noI! 1N8~ AFfOIUlt/Q O0V!A4ClE; WI\.I. INClIAVO" TO MAli. --30 DAY8 ~ITTEN NOTlC! To TH5
C!"TIFICJ\~ HOLllM NAIot!O HERI;lN. NT I'AILUIU TO MAIL SUCH NOTlO! SHALL I!.\POSII NO OIlL/OATION Oil
UASILITY 01' At<< ((IND UPON THlINIU"I"A~FOROINQ COVIIllAGI, 1'1'8 AGE;NTS Oil Il!PFl!8ENTATIVEI, Oil TH!
IS8U!!R OF THIS C5I1TII'IOAT!.
MAAISH ueA INC.
BY: Sheila D. Robertson S~ 0 ~
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;""~~IH!;t~~ .9..b.~iI01/19J06 :liW
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I^Jd9G: G 900G 'SG 'U'er
SJ!'e~~V l'e~al HJV
All Chlldren'9 Hospital
Legsl Department
801 6th Street South
St. Petersburg, FL 33701
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<<.~';) ..> 20-
- FAX COVER SHEET '.:. ~
ALL CHILDREN'S HEAJ- TH SYSTEM, INC.
801 Sixth Street South
St. Petersburg, FL 33701
Telephone: 727--898.7451
Website: www.allklds.org
Reference:
Date: CJ I - ~..s-- OC::,
To: ~i:
From (Sen r): Sharon Cotman, ,Paralegal ,
~4 1Jv~k>'1~A_
cc:
Total number of pages IncludIng cover sheet for this FAX: 0....
All Children's Hospital Sender's Contact Information:
FAX: (727) 767-8288
, Telephone:
(727), 767-4400
E-mail: cotmans@allkids.org
Department: Compliance/Legal Affairs
Internal Man Code: 9080
o Urgent D For Review J:l Please Comment J:l Please Reply 0 Please Recycle
Notes/Comments:
K e: purs1l1ant to our re uest, here i,s a oopY of the
~ertificate of Insu~ance for All Children's Hospital.
Because the hospital is self-insn~ed, the Long Center
~anno~ be listed as the insured entity. If you have any
auestions please direct them to Marty Clay,' Direot.or,
Risk Manaqement, (727) 767-4287.
Confidential & Privileged
uConfldentiallty Notice: This fax message, 'ncluding any attachments, Is for the so'e use of
'the intended reclpient(s) and may contain confidentIal and privifeged information. Any
unauthorized review, Use, dIsclosure or distribution Is prohIbited. If you are not the
Intended recipient, please contact the sender by replying either by fax, telephone or E-mail
and destroy all copies of the original."
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