HomeMy WebLinkAboutExhibit1612/22/2004 16:21
3055313747
FLAGSTONE PACE 02
DEPARTMENT OF RISK MANAGEMENT
INSURANCE/SAFETY APPROVAL FORM
Name
Aldo Bustamante
Department
ED
Review
Status
General Liability:
Automobile
Workers Comp:
Liquor Liability:
Builder Risk:
Professional Liability:
Garage Keepers Liability:
Excess Liability:
Fidelity Bond
Pollution:
Description
1st Amendment to agreement to enter into ground lease
Project #
Date:
11/19/2004
Financial
Ratings Strength REQUIREMENTS:
Insurance NOT Required
[]City of Miami is Named Additional Insured
] he City is providing insurance
FiCity of Miami is Loss Payee
rleayfront Park Named Additional insured
APPROVAL STATU
APPROVED
Frank Gomez
Insurance Coordinator
Patrice Novel
Safety/ADA Coordinator
nNot Approved
Coverage is insufficient
Not A Rated Company
A Type of Coverage is Missing
Other
The City NOT Named Additional Insured
Insurance/Safety Comments:
S/W Aldo of ED proposed amendment will change the room and key allocations in the hotel.
Risk 001 11/19/2004 2:37 PM