HomeMy WebLinkAboutSafety Approval FormDEPARTMENT OF RISK MANAGEMENT
INSURANCE/SAFETY APPROVAL FORM
Name
Ellyrosa Estevez
Department
Public Works
Review
Status
General Liability:
Assurance Company of America
Auto Liability:
Assurance Company of America
Workers Comp:
N/A
Liquor Liability:
Builder Risk:
Professional Liability:
Garage Keepers Liability:
Excess Liability:
&O Covegage
United States Liability
Pollution:
1'
Description
Miami River Fund
Tracking # Date:
4/1612004
Financial
Ratings Strength
A
A
A++
XV
XV
IX
REQUIREMENTS:
[—Ins[—Insurance NOT Required
urance
of Miami is Named Additional Insured
xx
r]me
City is providing insurance
City of Miami is Loss Payee
j 1Sayfront Park Named Additional Insured
APPROVAL STATUS
Frank Gomez
Insurance Coordinator
APPROJ1
19i
Patrice Nova!
SafetylADA Coordinator
Not Approved
Coverage is insufficient
Not A Rated Company
1
A Type of Coverage is Missing
Other
The City NOT Named Additional Insured
Insurance/Safety Comments:
Letter is in file from the Miami River Commission stating that presently only two emplloyees are
employed by the firm.
i
71
Risk003
4/16/2004
10:10 AM