HomeMy WebLinkAboutInsurance Safety FormDEPARTMENT OF RISK MANAGEMENT
INSURANCE/SAFETY APPROVAL FORM
Name
Ana Cobelo
Department
ER
Review
Status
General Liability:
Automobile
Workers Comp:
Liquor Liability:
Builder Risk:
Professional Liability:
Stella Maris Insurance Company
Garage Keepers Liability:
Excess Liability: /
Fidelity Bond /
Pollution:/
CM
Description
Mercy Medical Development dba Mercy Outpatient Center
Project #
Date:
10/29/2004
Financial
Ratings Strength REQUIREMENTS:
1
Insurance NOT Required
City of Miami is Named Additional Insured
The City is providing insurance
City of Miami is Loss Payee
Bayfront Park Named Additional Insured
APPROVAL STATUS
APPROVED
ANTED
Frank Gomez
Insurance Coordinator
Patrice Naval
Safety/ADA Coordinator
Not Approved
Coverage is insufficient A Type of Coverage is Missing
Not A Rated Company Other
The City NOT Named Additional Insured
Insurance/Safety Comments:
Drug Screening Testing -Professional Liability only exposure. No additional insured required.
Risk 001 10/29/2004 10:59 AM