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undertaking on behalf of or for the benefit of the insured or The words "damages because of bodily injury by
<br /> others, to determine or warrant that such workplaces, accident or disease, including death at any time
<br /> operations,machinery,or equipment are safe. resulting therefrom"in Coverage B include damages
<br /> for care and loss of services and damages for which
<br /> C. Insured's Duties in the Event of Injury,Claim or Suit the insured is liable by reason of suits or claims
<br /> (1) Notice of Injury brought against the insured by others because of
<br /> When an injury occurs, notice shall be given such bodily injury sustained by employees of the
<br /> immediately, in accordance with current reporting insured arising out of and in the course of their
<br /> procedures by the insured to the Fund. Such notice employment. The limits of liability for Coverage B
<br /> shall contain particulars sufficient to identify the are those established by Section 768.28, Florida
<br /> insured along with reasonably obtainable information Statutes.
<br /> respecting the time, place, circumstances of the (6) Other Insurance
<br /> injury, the names and addresses of the injured and Coverage A - If the insured has other insurance
<br /> all known witnesses. Such notice is to be directed to against a loss covered by this certificate, the Fund
<br /> the Division of Risk Management,State Employees' shall not be liable to the insured hereunder for(1)a
<br /> Workers'Compensation Claims, greater proportion of such loss than the amount
<br /> P. O. Box 8020, Tallahassee, Florida 32314-8020, which would have been payable under this
<br /> or to contract service vendor in accordance with certificate had no such other insurance existed, and
<br /> current reporting procedures. (2) the amount which would have been payable
<br /> (2) Notice of Claim or Suit under each other policy applicable to such loss had
<br /> If claim is made or suit or other proceedings is each such policy been the only policy so applicable.
<br /> brought against the insured, the insured shall Coverage B-If there is a valid and collectible policy
<br /> immediately forward to the Fund every demand, of insurance applicable to any otherwise valid claim
<br /> notice,summons,or other process received by it or hereunder,the coverage extended by this certificate
<br /> its representative. shall not apply.
<br /> (3) Assistance and Cooperation of the Insured (7) Subrogation
<br /> The insured shall cooperate with the Fund,and at its In the event of any payment under this certificate,
<br /> request, shall attend hearings and trials, assist in the Fund shall be subrogated to all rights of recovery
<br /> effecting settlements, secure and give evidence, therefor of the insured and any person entitled to the
<br /> obtaining the attendance of witnesses. The insured benefits of this coverage against any person or
<br /> shall not except at its own cost,voluntarily make any organization, and the insured shall execute and
<br /> payment, assume any obligation, or incur any deliver instruments and papers and do whatever
<br /> expense other than for such immediate medical and else is necessary to secure such rights. The insured
<br /> other services at the time of injury as are required by shall do nothing after loss to prejudice such rights.
<br /> the Workers'Compensation Law. (8) Cancellation
<br /> (4) Statutory Provisions-Coverage A Failure of the Fund to receive the amount of
<br /> The Fund shall be directly and primarily liable to any premiums billed to the insured agency within the
<br /> person entitled to the benefits of the Workers' time frames allowed by law may result in
<br /> Compensation Law under this certificate. The cancellation of the certificate of coverage.
<br /> obligations of the Fund may be enforced by such Payments must be made promptly from the insured's
<br /> person, or for his benefit, by any agency authorized operating budget upon receipt of the premium bill as
<br /> by law, whether against the Fund alone or jointly specified in Section 284.36, Florida Statutes, and
<br /> with the insured. As between the employee and\the lack of prompt payment will result in a request from
<br /> Fund,notice or knowledge of the injury on the part of the Fund to the Comptroller to transfer premiums
<br /> the insured shall be notice or knowledge, as the from any available funds of the delinquent agency
<br /> case may be, on the part of the Fund. The Fund under the provisions of Section 284.44(7), Florida
<br /> shall, in all things, be bound by and subject to the Statutes.
<br /> findings, judgments, awards, decrees, orders or (9) Terms of Coverage Conformed to Statute
<br /> decisions rendered against the insured in the form Terms of this certificate which are in conflict with the
<br /> and manner provided by law and within the terms, provisions of the Workers' Compensation Law, or
<br /> limitations, and provisions of this certificate not Section 768.28, Florida Statutes, are hereby
<br /> inconsistent with existing law. amended to conform to such laws.
<br /> All of the provisions of the Workers' (10) Self-Insurance Coverage
<br /> Compensation Law shall be and remain a part of this Coverage for defending and paying claims under this
<br /> coverage as fully and completely as if written herein certificate is provided under the authority of Chapter
<br /> insofar as coverage applies to compensation and 284,Florida Statutes,wherein the state is authorized
<br /> other benefits provided by this certificate and in to administer a self-insurance program. Provision of
<br /> respect to special taxes, payments into security or this certificate does not constitute the issuance of
<br /> other special funds,and assessments required of or insurance other than on a self-insurance basis, and
<br /> levied against compensation insurance carriers payment of any covered claim obligations is
<br /> under the Workers'Compensation Law. contingent upon availability of legislative funding.
<br /> The insured shall reimburse the Fund for any
<br /> payments required of the Fund under the Workers'
<br /> Compensation Law, which are made in excess of
<br /> the benefits regularly provided by such law, solely
<br /> because of injury to (a)any employee by reason of
<br /> the serious and willful misconduct of the insured, or
<br /> (b) any employee employed by the insured in
<br /> violation of law with the knowledge or acquiescence
<br /> of the insured or any executive officer thereof.
<br /> (5) Limits of Liability-Coverage B
<br /> DFS-DO-467
<br /> Revised 8/09 Page 2 of 2
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