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TRANSCRIPT
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject tothe terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement(s).
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS.
X
XX
XX
X X
XX
XX
04/28/2016
KQ5GC8A4
Risk Transfer Insurance Agency, LLC219 E. Livingston StreetOrlando, FL 32819
All Source Recruiting Group, Inc. dba Ardor Health Solutions5830 Coral Ridge Drive, Ste 300Coral Springs, FL 33076
Commerce and Industry Insurance Company
ZURICH AMERICAN INSURANCE COMPANY
American Guarantee & Liability Insurance Company
American Zurich Ins Co
19410
B
D
C
A
B
PRA590831203
PRA590831203
UMB651314202
WC1613000 (AOS)WC1613001 (CA Only)
PRA590831203PRA590831203PRA590831203PRA590831203
Abusive Acts: $3M/$3M
EBL $1m/$2m
0
Professional Liability/Medical ProfessionalLiabilityCrimeEmployment Practices Liability
03/01/2016 03/01/2017
03/01/2016 03/01/2017
03/01/2016 03/01/2017
03/01/2016 03/01/2017
03/01/2016 03/01/2017
Collier County Public Schools5775 Osceola TrailNaples, FL 34109
1,000,000
100,000
10,000
1,000,000
3,000,000
3,000,000
1,000,000
1,000,000
1,000,000
1,000,000
1,000,000
1,000,000
Prof Liab - Each ClaimProf Liab - AggregateEmployee DishonestyEPLI - Each ClaimEPLI - Aggregate
1,000,0003,000,000
100,0001,000,0002,000,000
Stop Gap : $1m/$1m/$1m/ - Policy #PRA590831203, term 3/1/16 to 3/1/17 (Ohio, Washington & Wyoming); Certificate holders are included as Additional Insured in additionto affording Waiver of Subrogation with respect to General Liability & Hired & Non-Owned Automobile; Primary & NonContributory applies with respect to General Liability &Hired & Non-Owned Auto; Waiver of Subrogation, Alternate Employer Endorsement also applies to certificate holder under Workers Compensation; all as required by writtencontract or agreement, subject to the terms, conditions and exclusions within the policy.
$
Tami Bolling
407-481-9363
Page 1 of 1
CERTIFICATE HOLDER
© 1988-2014 ACORD CORPORATION. All rights reserved.ACORD 25 (2014/01)
AUTHORIZED REPRESENTATIVE
CANCELLATION
DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
OTHER:
LOCJECTPRO-
POLICY
GEN'L AGGREGATE LIMIT APPLIES PER:
OCCURCLAIMS-MADE
COMMERCIAL GENERAL LIABILITY
PREMISES (Ea occurrence) $DAMAGE TO RENTEDEACH OCCURRENCE $
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
PRODUCTS - COMP/OP AGG $
$RETENTIONDED
CLAIMS-MADE
OCCUR
AGGREGATE $
EACH OCCURRENCE $UMBRELLA LIAB
EXCESS LIAB
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
INSRLTR TYPE OF INSURANCE POLICY NUMBER
POLICY EFF(MM/DD/YYYY)
POLICY EXP(MM/DD/YYYY) LIMITS
PERSTATUTE
OTH-ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
$
$
$
ANY PROPRIETOR/PARTNER/EXECUTIVE
If yes, describe underDESCRIPTION OF OPERATIONS below
(Mandatory in NH)OFFICER/MEMBER EXCLUDED?
WORKERS COMPENSATIONAND EMPLOYERS' LIABILITY Y / N
AUTOMOBILE LIABILITY
ANY AUTOALL OWNED SCHEDULED
HIRED AUTOSNON-OWNED
AUTOS AUTOS
AUTOS
COMBINED SINGLE LIMIT
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE $
$
$
$
$
INSDADDL
WVDSUBR
N / A
$
(Ea accident)
(Per accident)
The ACORD name and logo are registered marks of ACORD
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
INSURED
PHONE(A/C, No, Ext):
PRODUCER
ADDRESS:E-MAIL
FAX(A/C, No):
CONTACTNAME:
NAIC #
INSURER A :
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
INSURER(S) AFFORDING COVERAGE
$$$$$
^ C C P S C o l i i s r C o u n t y Public Schools
Purchasing
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P l e a s e i n d i c a t e y o u r i n t e n t i o n s b y c h e c k i n g / i n i t i a l i n g t h e a p p r o p r i a t e i n f o r m a t i o n a s r e q u e s t e d b e l o w .
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2 0 1 5 - 1 6 c o n t r a c t ( b i d t a b u l a t i o n f r o m l a s t y e a r i s a t t a c h e d ) .
i a m a g r e e a b l e t o r e n e w , a t a d i s c o u n t e d r a t e f r o m t h e 2 0 1 5 - 1 6 c o n t r a c t p r i c i n g . I h a v e a t t a c h e d
a c o n c i s e a n d t h o r o u g h b r e a k d o w n o f n e w t e r m s f o r r e v i e w t o i n c l u d e p e r c e n t a g e o f d e c r e a s e .
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Y o u r p r o m p t , u r g e n t a t t e n t i o n i s r e q u e s t e d . P l e a s e c o m p l e t e t h i s f o r m i n f u l l a n d r e t u r n t h i s l e t t e r , v i a f a x t o t h e
P u r c h a s i n g D e p a r t m e n t , ( 2 3 9 ) 3 7 7 0 0 7 4 o r v i a e - m a i i t o : R o b e r t P a @ c o l l i e r s c h o o l s . c o m , w i t h y o u r r e s p o n s e n o
l a t e r t h a n F r i d a y , A p r i l 2 9 , 2 0 1 6 . I f y o u h a v e a n y q u e s t i o n s o r c o n c e r n s , p l e a s e d o n o t h e s i t a t e t o c o n t a c t m e .
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Todays Learners • Tomorrow's Leaders
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W-9 F o r m ( R e v . D e c e m b e r 2 0 1 4 ) D e p a r t m e n t o f t h e T r e a s u r y I n t e r n a l R e v e n u e S e r v i c e
Request for Taxpayer Identification Number and Certification
Give Form to the requester. Do not send to the IRS.
1 N a m e ( a s s h o w n o n y o u r i n c o m e t a x r e t u r n ) . N a m e i s r e q u i r e d o n t h i s l i n e ; d o n o t l e a v e t h i s l i n e b l a n i < .
Comprehensive Therapy Consultants, Inc. 2 B u s i n e s s n a m e / d i s r e g a r d e d e n t i t y n a m e , i f d i f f e r e n t f r o m a b o v e
• T r u s t / e s t a t e 3 C h e c l < a p p r o p r i a t e b o x f o r f e d e r a l t a x c l a s s i f i c a t i o n ; c h e c k o n l y one o f t h e f o l l o w i n g s e v e n I x i x e s :
I I I n d i v i d u a l / s o l e p r o p r i e t o r o r C I C C o r p o r a t i o n [ 7 ] S C o r p o r a t i o n d P a r t n e r s h i p s i n g l e - m e m b e r L L C
0 L i m i t e d l i a b i l i t y c o m p a n y . E n t e r t h e t a x c l a s s i f i c a t i o n ( C = C c o r p o r a t i o n , S = S c o r p o r a t i o n , P = p a r t n e r s h i p ) • Note. F o r a s i n g l e - m e m b e r L L C t h a t i s d i s r e g a r d e d , d o n o t c h e c k L L C ; c h e c k t h e a p p r o p r i a t e t x i x i n t h e l i n e a b o v e f o r t h e t a x c l a s s i f i c a t i o n o f t h e s i n g l e - m e m t s e r o w n e r .
1 I O t h e r ( s e e i n s t r u c t i o n s ) •
4 E x e m p t i o n s ( c o d e s a p p l y o n l y t o c e r t a i n e n t i t i e s , n o t i n d i v i d u a l s ; s e e i n s t r u c t i o n s o n p a g e 3 ) : E x e m p t p a y e e c o d e (if a n y )
E x e m p t i o n f r o m F A T C A r e p o r t i n g c o d e (if a n y ) {Applies to accounts maintained outside ttK U.S.)
5 A d d r e s s ( n u m t ) e r , s t r e e t , a n d a p t . o r s u i t e n o . )
PO Box 310686 6 C i t y , s t a t e , a n d Z I P c o d e
Atlanta, GA 31131
R e q u e s t e r ' s n a m e a n d a d d r e s s ( o p t i o n a l )
7 L i s t a c c o u n t n u m b e r ( s ) h e r e ( o p t i o n a l )
Taxpayer Identification Number (TIN) E n t e r y o u r T I N i n t h e a p p r o p r i a t e b o x . T h e T I N p r o v i d e d m u s t m a t c h t h e n a m e g i v e n o n l i n e 1 t o a v o i d b a c k u p w i t h h o l d i n g . F o r i n d i v i d u a l s , t h i s i s g e n e r a l l y y o u r s o c i a l s e c u r i t y n u m b e r ( S S N ) . H o w e v e r , f o r a r e s i d e n t a l i e n , s o l e p r o p r i e t o r , o r d i s r e g a r d e d e n t i t y , s e e t h e P a r t I i n s t r u c t i o n s o n p a g e 3. F o r o t h e r e n t i t i e s , i t I s y o u r e m p l o y e r i d e n t i f i c a t i o n n u m b e r ( E I N ) . If y o u d o n o t h a v e a n u m b e r , s e e How to get a TIN o n p a g e 3.
Note. If t h e a c c o u n t i s i n m o r e t h a n o n e n a m e , s e e t h e i n s t r u c t i o n s f o r l i n e 1 a n d t h e c h a r t o n p a g e 4 f o r g u i d e l i n e s o n w h o s e n u m b e r t o e n t e r .
Social security number
or Employer identification number
5 8 - 1 5 8 3 5 8 7
Certification Part II U n d e r p e n a l t i e s o f p e r j u r y , I c e r t i f y t h a t : 1. T h e n u m l s e r s h o w n o n t h i s f o r m i s m y c o r r e c t t a x p a y e r i d e n t i f i c a t i o n n u m b e r ( o r I a m w a i t i n g f o r a n u m b e r t o b e i s s u e d t o m e ) ; a n d
2 . I a m n o t s u b j e c t t o b a c k u p w i t h h o l d i n g b e c a u s e : (a) I a m e x e m p t f r o m b a c k u p w i t h h o l d i n g , o r (b) I h a v e n o t b e e n n o t i f i e d b y t h e I n t e r n a l R e v e n u e S e r v i c e ( I R S ) t h a t 1 a m s u b j e c t t o b a c k u p w i t h h o l d i n g a s a r e s u l t o f a f a i l u r e t o r e p o r t a l l i n t e r e s t o r d i v i d e n d s , o r (c) t h e I R S h a s n o t i f i e d m e t h a t I a m n o l o n g e r s u b j e c t t o b a c k u p w i t h h o l d i n g ; a n d
3 . I a m a U . S . c i t i z e n o r o t h e r U . S . p e r s o n ( d e f i n e d l i e l o w ) ; a n d
4 . T h e F A T C A c o d e ( s ) e n t e r e d o n t h i s f o r m (rf a n y ) i n d i c a t i n g t h a t I a m e x e m p t
Certification Instructions. Y o u m u s t c r o s s o u t i t e m 2 a b o v e i f y o u h a v e b e e n b e c a u s e y o u h a v e f a i l e d t o r e p o r t a l l i n t e r e s t a n d d i v i d e n d s o n y o u r t a x r e t u r n , i n t e r e s t p a i d , a c q u i s i t i o n o r a b a n d o n m e n t o f s e c u r e d p r o p e r t y , c a n c e l l a t i o n o f g e n e r a l l y , p a y m e n t s o t h e r t h a n i n t e r e s t a n d d i v i d e n d s , y o u a r e n o t r e q u i r e d t o i n s t r u c t i o n s o n p a g e 3.
f r o m F A T C A r e p o r t i n g i s c o n - e c t .
n o t i f i e d b y t h e I R S t h a t y o u a r e c u n - e n t l y s u b j e c t t o b a c k u p w i t h h o l d i n g F o r r e a l e s t a t e t r a n s a c t i o n s , i t e m 2 d o e s n o t a p p l y . F o r m o r t g a g e d e b t , c o n t r i b u t i o n s t o a n i n d i v i d u a l r e t i r e m e n t a r r a n g e m e n t ( I R A ) , a n d s i g n t h e c e r t i f i c a t i o n , b u t y o u m u s t p r o v i d e y o u r c o r r e c t T I N . S e e t h e
Sign Here Date^
General Instructions S e c t i o n r e f e r e n c e s a r e t o t h e I n t e r n a l R e v e n u e C o d e u n l e s s o t h e r w i s e n o t e d . Future developments. I n f o r m a t i o n a b o u t d e v e l o p m e n t s a f f e c t i n g F o r m W - 9 ( s u c h a s l e g i s l a t i o n e n a c t e d a f t e r w e r e l e a s e i t ) i s a t wwwJrs.govffwQ.
Purpose of Form A n i n d i v i d u a l o r e n t i t y ( F o r m W - 9 r e q u e s t e r ) w h o i s r e q u i r e d t o f i l e a n i n f o r m a t i o n r e t u r n w i t h t h e I R S m u s t o b t a i n y o u r c o r r e c t t a x p a y e r i d e n t i f i c a t i o n n u m b e r ( T I N ) w h i c h m a y be y o u r s o c i a l s e c u r i t y n u m t s e r ( S S N ) , i n d i v i d u a l t a x p a y e r i d e n t i f i c a f i o n n u m b e r ( I T I N ) , a d o p t i o n t a x p a y e r i d e n t i f i c a t i o n n u m t > e r ( A T I N ) , o r e m p l o y e r i d e n t i f i c a t i o n n u m t j e r ( E I N ) , t o r e p o r t o n a n i n f o r m a t i o n r e t u r n t h e a m o u n t p a i d t o y o u , o r o t h e r a m o u n t r e p o r t a b l e o n a n I n f o r m a t i o n r e t u r n . E x a m p l e s o f i n f o r m a t i o n r e t u r n s i n c l u d e , b u t a r e n o t l i m i t e d t o , t h e f o l l o w i n g : • F o n r i 1 0 9 9 - I N T ( i n t e r e s t e a r n e d o r p a i d ) • F o r m 1 0 9 9 - D I V ( d i v i d e n d s , i n c l u d i n g t h o s e f r o m s t o c k s o r m u t u a l f u n d s ) • F o r m 1 0 9 9 - M I S C ( v a r i o u s t y p e s o f i n c o m e , p r i z e s , a w a r d s , o r g r o s s p r o c e e d s ) • F o r m 1 0 9 9 - B ( s t o c k o r m u t u a l f u n d s a l e s a n d c e r t a i n o t h e r t r a n s a c t i o n s b y b r o k e r s ) • F o r m 1 0 9 9 - S ( p r o c e e d s f r o m r e a l e s t a t e t r a n s a c t i o n s ) • F o m i 1 0 9 9 - K ( m e r c h a n t c a r d a n d t h i r d p a r t y n e t w o r k t r a n s a c t i o n s )
• F o r m 1 0 9 8 ( t i o m e m o r t g a g e i n t e r e s t ) , 1 0 9 8 - E ( s t u d e n t l o a n i n t e r e s t ) , 1 0 9 8 - T ( t u i t i o n ) • F o r n i 1 0 9 9 - C ( c a n c e l e d d e b t ) • F o n n 1 0 9 9 - A ( a c q u i s i t i o n o r a b a n d o n m e n t o f s e c u r e d p r o p e r t y )
U s e F o r m W - 9 o n l y i f y o u a r e a U . S . p e r s o n ( i n c l u d i n g a r e s i d e n t a l i e n ) , t o p r o v i d e y o u r c o r r e c t T I N .
If you do not return Form W-9 to the requester witty a T W , you might b e subject to tiackup withholding. S e e What is tmckup withholding? o n p a g e 2 .
B y s i g n i n g t h e f i l l e d - o u t f o r m , y o u : 1 . C e r t i f y t h a t t h e T I N y o u a r e g i v i n g i s c o r r e c t ( o r y o u a r e w a i t i n g f o r a n u m b e r
t o b e i s s u e d ) , 2 . C e r t i f y t h a t y o u a r e n o t s u t > j e c t t o b a c k u p w i t h h o l d i n g , o r 3 . C l a i m e x e m p t i o n f r o m b a c k u p w i t h h o U i n g i f y o u a r e a U . S . e x e m p t p a y e e . If
a p p l i c a b l e , y o u a r e a l s o c e r t i f y i n g t h a t a s a U . S . p e r s o n , y o u r a l l o c a b l e s h a r e o f a n y p a r t n e r s h i p i n c o m e f r o m a U . S . t r a d e o r b u s i n e s s i s n o t s u b j e c t t o t h e w i t h h o l d i n g t a x o n f o r e i g n p a r t n e r s ' s h a r e o f e f f e c t i v e l y c o n n e c t e d i n c o m e , a n d
4 . C e r t i f y t h a t F A T C A c o d e ( s ) e n t e r e d o n t h i s f o r m ( i f a n y ) I n d i c a t i n g t h a t y o u a r e e x e m p t f r o m t h e F A T C A r e p o r t i n g , i s c o r r e c t . S e e What is FATCA reporting? o n p a g e 2 f o r f u r t h e r i n f o r m a t i o n .
C a t . N o . 1 0 2 3 1 X F o r m W-9 ( R e v . 1 2 - 2 0 1 4 )
