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DEPARTMENT OF FINANCIAL SERVICES
<br /> Division of Risk Management
<br /> STATE RISK MANAGEMENT TRUST FUND
<br /> STATE EMPLOYEE WORKERS' COMPENSATION AND
<br /> EMPLOYER'S LIABILITY
<br /> CERTIFICATE OF COVERAGE
<br /> In consideration of the provisions and stipulations contained herein or added hereto and for the premium charged, the State Risk Management Trust
<br /> Fund, hereinafter referred to as the "Fund", certifies that the State department or agency named in this certificate is hereby entitled to workers'
<br /> compensation coverage as set forth in the Workers' Compensation Laws and to employer's legal liability coverage as established herein. Coverage
<br /> shall be effective on the inception date at 12:01 a.m.,standard time.
<br /> This certificate is comprised of the foregoing provisions and stipulations,together with such other provisions and stipulations as may be added hereto by
<br /> the Fund in the future:
<br /> I. Coverages directly from a bodily injury by accident is included within
<br /> A. Coverage A-Workers'Compensation the term"bodily injury by accident". The term"bodily injury
<br /> To pay promptly when due all compensation and other by disease"includes only such disease as is not included
<br /> benefits required of the insured by the Workers' within the term"bodily injury by accident".
<br /> Compensation Laws. (d) Assault and Battery - Under Coverage B, Assault and
<br /> Battery shall be deemed an accident unless committed by
<br /> B. Coverage B-Employer's Liability or at the direction of the insured.
<br /> To pay on behalf of the insured all sums which the insured
<br /> shall become liable to pay as damages because of bodily IV. Applications of Coverage
<br /> injury by accident or disease, including death,at any time This certificate applies only to (1) injury by accident occurring
<br /> resulting therefrom, which are sustained by an employee during the coverage period,or(2)occupational injury by disease
<br /> of the insured and which arise out of and in the course of as such is defined by law which occurs during the coverage
<br /> his employment with the insured in the United States of period.
<br /> America,its territories or possessions,or while temporarily
<br /> employed outside the United States of America, its V. Exclusions
<br /> territories or possessions. This certificate does not apply under Coverage B:
<br /> (a) to any claim or judgment for punitive damages;
<br /> II. Defense,Settlement,Supplementary Payments (b) to any claim for interest for the period prior to judgment;
<br /> As respects the insurance afforded by the other terms of this (c) to that portion of a claim or judgment which is in excess of
<br /> certificate,the Fund shall: the statutory limits of liability;
<br /> (a) defend any proceeding against the insured seeking such (d) to liability assumed by the insured or any third party
<br /> benefits and any suit against the insured alleging such pursuant to any contract or agreement in writing;
<br /> injury and seeking damages on account thereof, even if (e) to any obligation for which the named insured or any
<br /> such proceeding or suit is groundless,false,or fraudulent. carrier
<br /> The Fund will investigate all claims filed against the as his insurer may be held liable under any workers'
<br /> insured in order to determine the legal liability of the compensation, unemployment compensation or disability
<br /> insured and to determine damages sustained by the benefits laws,or under any similar law;
<br /> claimant. The Fund will negotiate,settle,or deny the claim (f) to any action by officers,employees,agents,or volunteers
<br /> based on these findings and appropriate Florida law. as defined in Chapter 110, Part V, Florida Statutes,
<br /> (b) pay all expenses incurred by the Fund, all costs taxed committed in bad faith, or with malicious purpose or in a
<br /> against the insured in any such proceeding or suit,and all manner exhibiting wanton and willful disregard of human
<br /> interest accruing after entry of judgment until the Fund has rights,safety,or property.
<br /> paid, tendered, or deposited in court such part of such
<br /> judgment as does not exceed the limit of the Fund's liability VI. Conditions:
<br /> thereon; A. Premium
<br /> (c) pay amounts incurred under this insuring certificate, Premium charges shall be assessed in accordance with
<br /> except settlements of claims and suits, in addition to the the provisions of Chapter 284, Part II, Florida Statutes,
<br /> amounts payable under Coverage A,or the applicable limit and any rules promulgated thereunder utilizing a
<br /> of liability under Coverage B. retrospective rating arrangement premium calculation
<br /> method whereby 80%of the premium is based on losses
<br /> III. Definitions actually incurred by the insured and 20% is based on the
<br /> (a) Workers'Compensation Law-The workers'compensation changes in risk exposures(employees,volunteers,etc.)of
<br /> law and any occupational disease law of a state an insured. The premium must be paid promptly by an
<br /> designated in this certificate, but does not include those insured agency from its operating budget upon receiving
<br /> provisions of any such law which provide non-occupational the premium bill or invoice.
<br /> disability benefits.
<br /> (b) State - Any state or territory of the United States of B. Inspection
<br /> America and the District of Columbia. The Fund shall be permitted, but not obligated,to inspect
<br /> (c) Bodily Injury by Accident-Bodily Injury by Disease-The at any reasonable time, the workplaces, operations,
<br /> contraction of disease is not an accident within the machinery, and equipment covered by this certificate.
<br /> meaning of the word"accident",as used in the term"bodily Neither the right to make inspections, nor the making
<br /> injury by accident", and only such disease as results thereof, nor any report thereon shall constitute an
<br /> DFS-DO-867
<br /> Revised 8/09 Page 1 of 2
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