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Fort Walton Beach Council agenda — 09-14-2010 Special-City Attorney Condidates — reading text
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information by the State of Florla
uenlot nd ar smiled u der
Weral enleft Mto this policyMyou—
conm t toll* rele" motion.
We will safeguard g matlon and maintain Ns corMentioRy. We will limit use of Vve lift go to "^"
complim-ce wph the terms of the policy.
This endorsement oranges the poky to which a is atseched and is effective on the date beml w* n otherwise slated.
The Information below Is required only when this andomement Is bond subsequent to pneperallon of" poky.)
Endo -mv at AUa 2010 Effective Policy No: 01 FU3.249MI -M Endorsement No.
hills I Mallhews & Hawkins, P.A. Premium
Comp Options insurance Company
Camber by
WC 09 06 06
Ed. 10.SM
1.
O NO IICWAWfnC0WfSMNMkWAWM
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0
COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POUCY WC 110111100 A
1st Reprint E1be Uve ApdV 1, 1902 Sandard
WORKERS COMPENSATION AND EMPLOYERS LUUNLITY INSURANCE POLICY
in return for the papwK of the prernsitem and subject to PART ONE
all terns of tta poky, we agree with you as WORKERS COMPENSATION MIStIRANCE
A. How This Insurance Apples
This workers oonrpensetion knstrrw= appdss to
bocdly l* ry by accident or boft Injury by cheese.
A. The Poliny Bodly " Mncludss res11111- death.
This 1101107 includes at its effective date the Inibr-
1. Bodily ktjury by accident most am during do
nation POP and d endorsements and schedules
IWAd thaa it is a cordrsct of hnsumne a awsan Policy period.
you (the employer eearna in Item 1 of to knfoema- 2. Bodily Inj vyy by dsease must be caused or
don Paps) and us (the how, r ono eed on the Infor- appravatsd by the coreclillons of your
matlon Papej. The only ag eemseels rolet to lNe erreployrnent.The 1iepioyee's last day of Isst
insurance are sated In this policy. The tarnm of this exposure to the cors cilliorm cng or
Jill
spy mey not be changed or waived am" by grsvatng Stich bof Its by dissese,must
endorsement issued by us to be pact oftits policy. occsu aft" PO lnsriod.
B. m vm Pay
B. Who IS, insured
YOU era cured IYOU we an en ifter named In We will pay prom;* when due the boneflts regt*
tern 101# 0 InfIslion Page. If dmt empkW is a of you by " Wafts oompensatorh few.
pertnarship, and if you are one of a pariners, you
C. We W10 D~
are Insured, but only In yotu copecky as an em.
plover of the pap's employees. We have the right and duly to defend at our sxpen: e
any claim, proceee lk " or cut against you for beneoa
a!
C. Workers Comparmation Law payable by the khsuaaoe. We have the right to in-
veMipate and settle these cdairns, proceedings o<
Workers Compensatlon Law mien the workers or I
saris.
workmen's octetfeerhsaton law and oocup ill
disease law of each state or teMtory named in lam We have no duty to defend a clohn, proceeding or
3A of to khtorn" on Page. it Includes any sari teat is not covered by this kwrancs.
momrh 11- 0 Ms to tmt low which are in elfed doing D. We Will Also Pay
the Poft period. It does not hhclUde any federal
workers orworin un's oornpo - en orn law. arhy fed - We will also pay these cosa, In addition to other
oocupatonai daesue law or the prwAslorm of antouha payable under phis Insurances as pact of
any low OW provide rhonoocupetan i dbWft any daim, proceeding or auk via defend:
beneft
1. expenses ktcurred at our request,
1000" 1 _ 00
O. 8tate but not loss of earnings;
2. premiums for bonds to release attachments
sale meets any state of the Unw Sates of
America, end the DbMct of Colmuble. and for appeal bonds In bond ereeouea up to
the amount payable under this insurer=;
E. Location 3. Option costs taxed against yon;
This pok7 covers all of your workplaces lisled In 4. btetest on a Aftmant as required bylaw ur d
Ilems 1 or 4 of the bhtonrmUorh Page; and it covers we offer the amount due under this inswarm
ON oliW woricpleces in tteen 3.A. states unless you end
have other insurenoa or are sell-insuresd tar such 5. expenses;we iruxrr.
worwaces.
E. Other ho an©e
We wtq not pay more than our share of benefKs and
coots covered by this inawwm mid otter
1 of 6
0 I 110" GowdleaGew* emewhows .
WC 00 00 00 A WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
stendsord 1, 19902 IstReprm
btsurance or self-insurance. Subject to any knits of
warners cc ipensstlon mew that apply to:
Mabry that may apply, ea own vA be egwi UMN
a. bona is payable by fls insurance;
the loss is paid. K any bye or self-insurance
Is exhauste4 qw slctres of all remaining insurance b. aped tmw peps inb security or
wM be equal until the lon la paid. afar special funds, and aesesernerts pay-
able by us under that taw.
F. Psymenb You Must Mola B. Temps of this Insurance 10 oormft wif the
You are fesponsibls for any psynrents in excess of workers oompensa0ort law are c>mnged by this
atatenment b conform to that law.
Me benefits regularly provided by ft workers
compensation low Inc' xft those required be- Nodft in these paragraphs relieves you of your du-
cause:
ties undw this poky.
1. of your serious and wWW misconduct;
2. you knowingly emptoy an employee in violatlon PART TWO
allows EMPLOYERS LIABILITY INSURANCE
3. you lag to comply wkh s health or safety law or A. Now This,Insurance Appiles
or
4. you discimp, gnu co or otherWae disc hrtktale Thla onVOYSM B@bMy ir ioe qWn to badly
any employes in vlolo* m of the workers injury by socklent or badly " by dissess. Bad 1y
oo lip ertsaiiat law. Injury includes resuMrtg deaf.
1. The bodlly Irfury must arise out of end in the
If we make any payments In excess of the bwwfns
mgulerill provided by fe workers oompensellon course of the k* ved employee's employment by
you.
law on your behalf, you wB reirmburse us promptly.
2. The employment must be necessary or ktdden-
C. Recovery From Othets
tol to your work In a stele or territory ft %
d in
We have your rV ts, and Me rlplmts of persona end. Nam 3.A. of the NmMwrnstlon Pape.
VW to the beneft of this insurance, to recover our 3.
Peyntenis morn anyone 11"
Badly Intel by accident must oocma wing ft
for to injury. You wMl Posy pfd•
do eve" ft necessary to protect fuse rights for
4. Soft " by disease must be caused or W
us and to help us enfa ce fern.
gravated by the cones of your
H. The erployee led day of lest exposure 10 the
stdomy PrWAsIons
These statements apply where they are required by candillons coWntg or aggraeaiing such badly In-
law. jury bydloesse must ooairdudrmg the policy W
riod.
1. As batweenm an k* xed worker and us,,we have
S. K you are sued, the oript W suk and any related
notice of the injury when you have notice.
