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HomeMy WebLinkAboutCRA-R-05-0040 Back-up documentationCity of Miami REQUEST FOR DIRECT PAYMENT INSTRUCTION: Please attach all the original documents related to expenditures, i.e., receipts, bills, invoices, etc. FROM TO a 2. Department 4. Date: CHIEF ACCOUNTANT, ACCOUNTING DIVISION, FINANCE DEPAITILMENT 5. Name: ft /A shin I- Ttno DESCRIPTION OF ITEM(S) TO BE PAID 7. - " 10. Check Distribution: Mail Direct to Vendor Return to Department 12. Approved - - 0 f Department Director/Designee Date Approved: f -- Finance/ ty Manger I Date 6. Address: Approved: *:;,_\ 2110.1 1"1 i7 I ACCOUNT CODE/ SUBSIDIARY NO. 301 ko. sc PAID `.,HECOOLzar AMON W.,11 iTIAL TOTAL PAYMENT 32)5-2'I AMOUNT qi9 Expenditure Control Date FOR FINANCE USE ONLY Vendor No: FOR REQUESTING DEPARTMENT USE ONLY Batch No: Pre -encumbered By Date: FN/AC 202 Rev. 12/89 Route: White and Canary copies to Expenditure Control and retain Pink copy. Disiribution: White and Canary - Finance {Accounting) Check No: Date: Control Number DP-. 9 9 75 0 0 Brown & Brown, Inc =� P.O. Box 2412 =; Daytona Beach, FL 32115-2412 Phone : 386-252-9601 Fax : 386-239-5729 CITY OF MIAMI CRA EVA IILPATRICK 49 NW 5TH ST SUITE 100 MIAMI, FL 33128 INVOICE# 40119 AccouNTNo: :' OP: >::C DAxTE:• :• :' MIAMI-9.... ..... TS 06/24/05 • :POLICY* 2CG8455 Essex Insurance Co Steve Farmer .vEFFECTIVe:: 06/23/04 OFMMERCMAL:PACKAGi 06/23/05 06/24/05 • • escrip INVOICE M 40119 • $ 8,979.00 aui1 164073 06/29 /05 REN PCKG Package $ 8,751.00 164074 06/24/05 CFE PCKG Company fees $ 228.00 Invoice Balance: $ 8,979.00 ays:,,tc.41 rt :44 MacDuffUnderwriters, Inc. t P.O. Box 2427 Daytona Beach, FL 32115-2427 Phone (386) 252-6454 * Fax (386) 257-5'799 RY 1• zaP THERESA SCHWAB BINDER No. 4IMS01192 Named Insured: CITY OF MIAMI COMMUNITY REDEVELOPMENT CENTER 49 NW 5TH ST SUITE 100 MIAMI FL 33128 Previous No. 2CG84 55 BROWN & BROWN - DAYTONA Name of Insurer(s) P 0 BOX 2412 ESSEX INSURANCE GROUP 100% DAYTONA BEACH FL 32115-2412 Fax: (386) 239-5729 Binder Effective: 06-23-05 to 07-23-05 Policy Effective: 06-23-05 to 06-23-06 12:01 A.M. Standard Time • Coverage Perils Limits Deductible Valuation Location(s) Subject To Terms & Conditions INLAND MARINE MISCELLANEOUS PROPERTY FLOATER -ALL RISK EXCLUDING QUAKE/FLOOD $50,000 SCHEDULED VALUE (SUBMIT 100% COINSURANCE $1,000 PER OCCURRENCE EXCLUDING ACV ON FILE WITH COMPANY SEE ATTACHED SEE ATTACHED Si'. t P f533S5 QUR1090D �` iJfN IYY,4 i FlUN, FEE 2Na UPAg'rAteiiRliT: BARK t0<'rE .. 0A7i: TAX FEES Cold, t:S rCMut/RE PREMIUM Policy Fee FL Catastrophe Fee $575.00 $35.00 $4.00 TOTAL $614.00 CONDITIONS: The Insurers bind the kind(s) of insurance stipulated above. This insurance is subject to the terms, conditions and limitations of the policy(ies) in current use by the Insurers. This binder may be cancelled by the insured by surrender of this binder or by w en notice to the Insurers stating when cancellation will be effective. This binder may bncelled by the Insurers by notice to the Insured in accordance with the policy conditions. This binder is cancelled when replaced by a policy. If this binder is not replaced by a policy, the Insurers are entitled to charge a premium for the binder according to the rules and rates in use by the Insurers. Date June 24, 2005 Authorized Representative: (OMNI+ 00O244-020808/0506241314) Company Copy Contact: CATHERINE SORRELL SUPPLEMENTAL TERMS AND CONDITIONS Reference Number: 4IMS01192 Name Insured: CITY OF MIAMI COMMUNITY Date: June 23, 2005 FORMS AND ENDORSEMENTS LISTED BELOW BUT NOT LIMITED TO: IMB-MPFAR MISC PROPERTY FLOATER -ALL RISK IMB-PPE PROPERTY POLLUTION EXCLUSION IMB-011-1097 ORGANIC PATHOGEN EXCLUSION IMB-0935 Y2K EXCLUSION IMB-003 MINIMUM EARNED PREMIUM 011-1095 PRIVACY NOTICE TER -TERRORISM EXCLUSION IMB-TOTLLOSS TOTAL LOSS ENDORSEMENT IMB-011-1002 ESSEX INLAND MARINE POLICY JACKET IMB-TL THEFT LIMITATION IMB-BLK THEFT IS EXCLUDED ON LAPTOPS AWAY FROM PREMISES IMPORTANT NOTICE REGARDING FEDERAL TERRORISM ACT OF 2002 You are hereby notified that under The Terrorism Risk Insurance Act of 2002 the policyholder must elect or decline this coverage. The additional premium to add this coverage is $ 150 plus tax/fees. At the time of binding we must have the attached MKL TERR 3(12/19/02) form signed by the policyholder. We will revise the the quote and forward to you if the policyholder elects the coverage. IF THE TERRORISM COVERAGE IS PURCHASED, THE COVERAGE CANNOT BE CANCELLED MID-TERM UNLESS THE ENTIRE POLICY IS CANCELLED. TERRORISM FORMS-(GEN LIAR) CG2169 TERRORISM EXCL IF COVERAGE ELECTED-(GEN LIAB): CG2177 CAP ON LOSSES CG2187 CONDITIONAL EXCL TERRORISM FORMS -(PROP & IM) 011-1096 TERRORISM EXCL IF COVERAGE ELECTED -(PROP & IM): IL0950 CAP ON LOSSES IL0995 CONDITIONAL EXCL SUBJECT TO: Form DEF-0033 PAGE: 1 OF 2 Company Copy (OMMI+ EF0033-020808/0506241314) SUPPLEMENTAL TERMS AND CONDITIONS Reference Number: 4IMS01192 Name Insured: CITY OF MIAMI COMMUNITY Date: June 23, 2005 SUBJECT TO: 1)COMPLETED ORIGINAL APP SIGNED BY INSURED 2}SATISFACTORY INSPECTION 3}WRITTEN ORDER TO BIND / DUE DILIGENCE 4)PREMIUM IS 25% MINIMUM EARNED IF INSURED CANCELS 5)PREMIUM IS MINIMUM & DEPOSIT, SUBJECT TO AUDIT 5)ALL POLICY FEES AND INSPECTIONS PEES ARE FULLY EARNED AND NON REFUNDABLE 7) MUST HAVE SIGNED APPLICATION, UPDATED SCHEDULE, SIGNED TERRORISM FORM AND DILIGENT EFFORT TO BIND COVERAGE • Form DEF-0033 PAGE: 2 OF 2 Company Copy (OMNI+ EF0033-02080810506241314) MacDuff Underwriters, Inc. P.O. Box 2427 Daytona Beach, FL 32115-2427 Phone i386) 252-6454 * Fax (386) 257-5799 C5 r- BINDER No. 2CH3233 Prey cue No. 2CG8455 C� THERESA SCHWAB BROWN & BROWN - DAYTONA P 0 BOX 2412 DAYTONA BEACH FL 32115-2412 Fax: (386) 239-5729 Binder Effective: 06-23-05 to 07-23-05 Policy Effective: 06-23-05 to 06-23-06 12:01 A.M. Standard Time Coverage Perils Limits Deductible Valuation Location(s) Subject To COMMERCIAL PACKAGE SPECIAL FORM EXCLUDING AND THEFT Named Insured: CITY OF MIAMI COMMUNITY REDEVELOPMENT CENTER 49 NW 5TH ST SUITE 100 MIAMI FL 33128 Name of Insurers) ESSEX INSURANCE GROUP 100% PVRPLUS UNES AGENT: MARK LOWE ADDRESS: 220 S. F;1o3EW001) WE. CM1 »!A 1001., 321 5 LC. / Alms: PROD. AGI. r;F. L�4 PROD. A r ADi 1 :.iS orr-tv, nr:1- ti "INNS J1,474.1PAY;'e::f WIND/HAIL, ,! F iT , FA7ITI QUAKg. �.I;,... x G A:J INSOLVENT ...e:.... LC:). 0. vJti:..-1. r ( i_a_ $130,000 BPP 80% COINS/$20,000 BI W 1 -l4£s—. ursa 'PREMIUM - TAX $3, 000, 000 GENERAL AGGREGATE FILING FEE FEES EXCLUDED PRODUCTS/COMPLETED OPS AGGREGATE COON1ERSIGN TUSE EXCLUDED PERSONAL AND ADVERTISING INJURY $3,000,000 EACH OCCURRENCE .1no)Lk r,1J $ 50,000 FIRE DAMAGE ANY ONE FIRE $ 1,000 MED EXP ANY ONE PERSON PROP - $1,000 AOP EXCLUDING WIND/HAIL GL - $1,000 BI/PD PER CLAIM INCLUDING LAE ACV ON FILE WITH COMPANY INLAND MARINE -SEPARATE QUOTATION Policy Fee Inspection Fee FL Catastrophe Fee $35.00 $150.00 $4 . 00 PREMIUM $8,176.00 FEES $189.00 TOTAL $8,365.00 CONDITIONS: The Insurers bind the kind(s) of insurance stipulated above. This insurance is subject to the terms, conditions and limitations of the policy(ies) in current use by the Insurers. This binder may be cancelled by the insured by surrender of this binder or by wr ten notice to the Insurers stating when cancellation will be effective. This binder may bncelled by the Insurers by notice to the Insured in accordance with the policy co itions. This binder is cancelled when replaced by a policy. If this binder is not replaced by a policy, the Insurers are entitled to charge a premium for the binder according to the rules and rates in use by the Insurers. Date June 24, 2005 Authorized Representative: d=w (OMNI+ DCO244.02080610506241316) ORIGINAL Copy Contact: CATHERINE SORRELL SUPPLEMENTAL TERMS AND CONDITIONS Reference Number: 2CH3233 Name Insured: CITY OF MIAMI COMMUNITY Date: June 23, 2005 FORMS AND ENDORSEMENTS LISTED BELOW BUT NOT LIMITED TO: 011-1054 SERVICE OF SUIT, COMMON POLICY CONDITIONS, NUCLEAR ENERGY LIAB EXCL, PRIVACY NOTICE CP0010 BUILDING AND PERSONAL PROPERTY COVERAGE FORM CPO090 COMMERCIAL PROPERTY CONDITIONS CP0125 FLORIDA CHANGES M/E-143 MINIMUM EARNED PREMIUM -AMENDMENT CGC001 COMMERCIAL GENERAL LIABILITY COVERAGE FORM CG0220 FLORIDA CHANGES -CANCELLATION AND NONRENEWAL M/E-048 DEDUCTIBLE LIABILITY M/E-001 COMBINATION ENDS'- DUTY TO DEFEND; EMPLOYERS' LIABILITY EXCL AMENDED; AUTO, AIRCRAFT & WATERCRAFT EXCL AMENDED; L EXCLUSIONS: PUNITIVE OR EXEMPLARY DAMAGE; DISCRIMINATION; EMPLOYMENT RELATED PRACTICES; ERRORS, OMMISSIONS, NEGLIGENT ACTS, PROFESSIONAL LIABILITY; MALPRACTICE; ANIMALS; BREACH OF CONTRACT; ASSAULT & BATTERY; SPORTS OR ATHLETICS; CROSS SUITS LIAB; INTELLECTUAL PROPERTY; TELEPHONE CONSUMER PROTECTION ACT; LIQUOR LIABILITY; CRIMINAL ACTS; INTERNET EXPOSURES; NEGLIGENT HIRING, TRAINING, SUPERVISION; WATER LEAKAGE,SEEPAGE, BACKUP OR OVERFLOW; LIMITATIONS: CLASSIFICATION; WHO IS AN INSD; SUPPLEMENTARY PAYMENTS-COV A&B; INSD CONTRACT; LESSOR'S RISK ONLY CLASSIFICATION M/E-002 ADDITIONAL CONDITIONS ENDT- SUBSIDENCE EXCL; POLLUTION EXCL; ASBESTOS, LEAD,SILICA,DUST, FUNGI,BAACTERIA EXCL; CONTRACTOR'S LIMITATION 011-1096 TERRORISM EXCLUSION CG2169 WAR OR TERRORISM EXCLUSION MKL TERR3 NOTICE OF TERRORISM INSURANCE COVERAGE ME009 ADDITIONAL INSURED ME067 EMPLOYEES, LEASED WORKERS, VOLUNTEERS EXCLUSION ME159 PERSONAL & ADVERTISING INJURY EXCLUSION ME173 PRODUCTS & COMPLETED OPERATIONS EXCLUSION ME217 LIMITATION OP COVERAGE TO DESIGNATED PREMISES CP0032 BUSINESS INCOME WITHOUT EXTRA EXPENSE CP1030 CAUSE OF LOSS SPECIAL FORM •m DEF-0033 PAGE: 1 OF 2 ORIGINAL Copy (0MNI+ EF0033-020808/0506241316) SUPPLEMENTAL TERMS AND CONDITIONS Reference Number: 2CH3233 Narne Insured: CITY OF MIAMI COMMUNITY CP1054 WINDSTORM AND HAIL EXCLUSION CP1033 THEFT EXCLUSION JGF9 PROTECTIVE SAFEGUARD (100* SPRINKLER SYSTEM) IMPORTANT NOTICE REGARDING FEDERAL TERRORISM ACT OF 2002 You are hereby notified that under The Terrorism Risk Insurance Act of 2002 the policyholder must elect or decline this coverage. The additional premium to add this coverage is $ 250 plus tax/fees. At the time of binding we must have the attached MXL TERR 3(12/19/02) form signed by the policyholder. We will revise the the quote and. forward to you if the policyholder elects the coverage. IF THE TERRORISM COVERAGE IS PURCHASED, THE COVERAGE CANNOT BE CANCELLED MID-TERM UNLESS THE ENTIRE POLICY IS CANCELLED. TERRORISM FORMS-(GEN LIAB) CG2169 TERRORISM EXCL IF COVERAGE ELECTED-(GEN LIAB): CG2177 CAP ON LOSSES CG2187 CONDITIONAL EXCL TERRORISM FORMS -(PROP & IM) 011-1096 TERRORISM EXCL IF COVERAGE ELECTED -(PROP & IM): IL0950 CAP ON LOSSES IL0995 CONDITIONAL EXCL SUBJECT TO: Date: June 23, 2005 1)COMPLETED ORIGINAL APP SIGNED BY INSURED 2)SATISFACTORY INSPECTION 3)WRITTEN ORDER TO BIND / DUE DILIGENCE 4)PREMIUM IS 25i MINIMUM EARNED IF INSURED CANCELS 5)PREMIUM IS MINIMUM & DEPOSIT, SUBJECT TO AUDIT 6)ALL POLICY FEES AND INSPECTIONS FEES ARE FULLY EARNED AND NON REFUNDABLE 7) BASED ON EXPIRING INFORMATION, IF ANY CHANGES, PLEASE ADVISE PRIOR TO BINDING COVERAGE 8) MUST HAVE SIGNED APPLICATION, SIGNED TERRORISM FORM AND DILIGENT EFFORT TO BIND COVERAGE Form DEF-0033 ORIGINAL Copy PAGE: 2 OF 2 (OMNI+ EF0033-02080810506241316} • II1 ESSEX INSURANCE COMPANY MARIEL The following spaces preceded by an ATTACHED TO AND FORMING PART OF POLICY NO. 2CG8455 Es NDORSEMENT ©tjPT asterisk (*) need not be completed if this endorsement and the policy have same inception date. ISSUED TO CITY OF MIAMI REVELOPMENT AGENCY 'EFFECTIVE DATE OF ENDORSEMENT 06/23/2004 IN CONSIDERATION OF RETURN SERVICE FEE THE RETURN SURPLUS LINES TAX $201.75 10.10 THE POLICY IS AMENDED TO DELETE THE TAXES AND FEE AS THIS IS A TAX EXEMPT AGENCY. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. c_Noszcl akwc097. . s (2-i.okwAxrat.o .7a.Lfki,,,a arvA LV Nothing herein contained shall be held to vary, alter, waive or extend any of the terms, conditions, provisions, agreements or limitations of the above mentioned Policy, other than as above stated. Authorized Representative MACDUFF UNDERWRITERS P 0 BOX 2427 DAYTONA BEACH, FL 32115 8-101070 In Witness Whereof the Company has caused this en- dorsement to be signed by a duly authorized represen- tativ of the Company AUTHORIZED EPRESENTATIVE 1 1 . 1009 (7-R0) INSURED 111 ESSEX INSURANCE COMPANY MARKEL ENDORSEME 6 Jai S0Tff, The following spaces preceded by an asterisk (*) need not be completed if this endorsement and the policy have same inception date. ATTACHED TO AND FORMING 'EFFECTIVE DATE 'ISSUED TO PART OF POLICY NO. OF ENDORSEMENT CITY OF MIAMI REDEVELOPMENT AGENCY 2CG8455 01/15/2005 IN CONSIDERATION OF THE RETURN SURPLUS LINES TAX $225.00 RETURN SERVICE FEE 11.25 THE POLICY IS AMENDED AS FOLLOWS: THE TAXES AND FEE ARE DELETED AS THIS IS A TAX EXEMPT AGENCY. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. Nothing herein contained shall be held to vary, alter, waive or extend any of the terms, conditions, provisions, agreements or limitations of the above mentioned Policy, other than as above stated. Authorized Representative MACDUFF UNDERWRITERS P 0 BOX 2427 DAYTONA BEACH, FL 32115 8-101070 In Witness Whereof the Company has caused this en- dorsement to be signed by a duly authorized represen- tative of the Company UTHHOORRIf2'ED i2RESENTATIVE OH - 1009 (7-80) INSURED