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HomeMy WebLinkAboutExhibit 17Attachment I: The City's Insurance Requirements for Provider with Provider's Insurance Certificates rjj:Document O1_PSA, v2.doc Florida Chamber of Commerce 1113 E. Tennessee Street 5200 Tallahassee FL 32308-6915 Phone:866-322 -7526 Fax:850-681-7737 INSURED Masa Tn..;tsorhr eyila wol1robdl* mi33132-1025' A201 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMINO, EXTEND OR ALTER THE COVERAGE AFFORDED UY THE POLICIES BELOW. INSURERS AFFORDING COVERAOE INSUR6Rk Zenith Insurance Company INSURER B: INSURER C: INSURER D; RAC* INSURER E: ) COVERAGES THC FOuCIES or INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM 0R CONDITION OF ARV CONTRACT OR OTHER DOCUMENT W RIi RESPECT TO WHICH THIS CERTIFICATE MAY 5E ISSUED OR OpewYI PERM Th INS LIMITS SHOWN HAY HAVE 9BEEN URANCE AFFORDED BY THE I REDUCED RI PAID REIN SUBJECT TO ALL THE TERMS, EXCLUSIONS AM) CONDm0' 5 OF SOCH IES A ATE IRaR POLICY NUA16FR DA DATE WHO NISEI TYPE OF INSURANCE GENERAL LIAELITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE ❑ OCCUR GEM AGGREGATE LSO APPLIES PER: —1 POLICY n JEOT n loc AMOMOLLE LIABLITY ANT AUTO ALL OWNED AUTOS SCIIGDULFD AUTOS HIRED AUTOE NON -OWNED AUTOS GARAGE LIABILITY RANT AUTO EXCiBBUM1RELLA LMIILRY OCCUR E CLAIMS MADE DEDUCTIBLE RE1EW ION E WORKERS CONPIDISATION AND EMPLOYER$ LtAILITY ANT PROPRICTORIPARTNER/EXECLff VE OF FICERfIIEHSER EXCLUDED? N pot ductam imd SPECIAL PROVISIONS b.loN OTHER Z049599703 04/02/05 04/02/0 DESCRIPTION OF OPERATIONS $ LOCATIONS f 'emits f EXCLUSIONS ADDED BY ENDORSCMENI 1 SPECIAL PROVISIONS CERTIFICATE HOLDER City of Miami Risk lta.nagumaft 9th Floor 444 SW 2 Avenue Miami FL 33130 CANCE4k.Afl0N uu n' EA' CH OCCURRENCE I - UAMW $b 1V HLN1 kU PREMISES (Ea 9w nenee) 1 MD EXP {AM GNI WOO) i PERSONAL I.ADVINJUIY 3 GENERAL AGGREGATE $ PRODUCTS-COMPiOPAGO S COMBINED SINGLE LA11T {EA •cctlani) 1 BODILY INJURY IP« IAWK1 1 BODILY INJURY imp swamp s PROPERTY DAMAGE {Pr acddow4 S AUTO ONLY • EA ACCIDENT 1 • THAN EA ACC 1 OTHER AUTO ONLY: AOG $ EACH OCCURRENCE i AGGREGATE E $ IS I - - 1 rU X I R WITS I I ER., E.L. EACH ACCIDENT i 100000 E.L. DISEASE - EA EIAPLOYEE 11 100000 lE.L. DISEASE - POLICYUMIT i 500000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE GANGS DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE IMPOSE NO OSUGA LIABIW ANY KIND REJRESENTA Au RIZ£D FDA Hausa ACORD 25 (200110 ) I I THE EXPIRATION L 10 DATE WRITTEN HALL IN , Mt AGENTS OR @ ACORD CORPORATION MS CSR MB ARTSF-1 DATE (MMJDDIYYYY) 12/28/05 ACORD, CERTIFICATE OF LIABILITY INSURANCE :ODUCER ORTON D. WEINER/AMPAC ORAL GABLES 62 MINORCA AVENUE ORAL GABLES FL 33134 hone:305-444-2324 Fax:305-444-4980 SURED ARTS FOR LEARNING'MIAMI INC. Sheila Womble 1900 Biscayne Blvd Ste 201 Miami FL 33132 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NA1C # INSURER A: Scottsdale Insurance Company INSURER B: INSURER C INSURER D: INSURER E: OVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. -"ISd�r- PI S r 1NSRC TYPE OF INSURANCE POLICY NUMBER T DATE (MMIODIYY) DATE IMMIDDM ) GENERAL LIABILITY X X COMMERCIAL GENERAL LIABILITY CP 5 0 6 7 6 8 9 8 12 / 0 5/ 0 5 12 / 0 5/ 0 6 1 CLAIMS MADE X OCGUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY n JECOT n LOC AUTOMOBILE LIABILITY ANY AUTO ALL.OWNEO AUTOS . SCHEDULED AUTOS., HIRED AUTOS NON -OWNED AUTOS Y GARAGE LIABILITY ANY AUTO EXCESSIUMBRELLA LIABILITY JOCCUR n CLAIMS MADE DEDUCTIBLE. RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY A.t'Y PROPRIETOR/PARTNER/EXECUTIVE OFFICERlMEMBER EXCLUDED? II yes, describe under SPECIAL PROVISIONS below OTHER LIMITS EACH OCCURRENCE $ S00,000 UAMAGEIL/ HtNEkU PREMISES (Ea occurence) $ 50,00(� MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY 1 500,000 GENERAL AGGREGATE $ 1, 0 0 0■ 0 0 0 PRODUCTS -COMP/OP AGG $ I., 0 0 0, 000 COMB4NED SINGLE LIMIT (Ee accident) $ BODILY INJURY.. .. . (Perper.son) $ BODILY INJURY (Per accdenl) $ PROPERTY DAMAGE (Per accident) $ AUTO ONLY - EA ACCIDENT $ EA ACC $ OTHER THAN AUTO ONLY: AGG $ EACH OCCURRENCE $ AGGREGATE $ $ $ I WC STATU- DTI+ $ ITORY LIMITS' 1 ER E.L. EACH ACCIDENT $ E.L. DISEASE- EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT _ $ )ESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS SCHOOL NOT FOR PROFIT- INCLUDES: VOLUNTEERS AND INDEPENDENT CONTRACTORS SEXUAL AND PHYSICAL ABUSE: $25,000 OCCURRENCE $50,000 AGGREGATE * 10 DAYS NOTICE OF CANCELLATION FOR NON PAYMENT OF PREMIUM CERTIFICATE HOLDER CITYMIA CITY OF MIAMI RISK MANAGEMENT 9TH FLOOR 444 SW 2 AVE, 8TH FLOOR MIAMI FL 33130 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL. ENDEAVOR TO MAIL 3 0 * DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY HIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. © ACORD CORPORATION 1988 ACORD 25 (2001/08) City oMiami Department of Risk Management 9th Floor 444 SW 2nd Avenue, 61h Floor Miami FL 33130 To Whom It May Concern: Arts for Learning/Miami staff will not be using personal vehicles or automobiles in conjunction with services The provided ao the andty of Miami under Arts for Learning,the Inc. or Out -of -School Parks Grant 2005-06. betweenrofessional Service Agreement by and The City of Miami In addition, Arts for Learning/Miami does not own or operate company vehicles. ARTSEciLEARNI\M MIA MI Biscayne blvd.,305.5 6t1212ite 201 m(.305.57fi 1193 www.arts41earning,org