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HomeMy WebLinkAboutCRA-R-06-0041 Back-uprr-wr174wx qua.rrw;aa�,,.�,�;aw�(r,,a,.,rt7pv•t,; r cou.pitei City of Miami REQUEST FOR DIRECT PAYMENT. INSTRUCTION: Please attach ail the original documents related to expenditures, i.e., receipts, bills, invoices, etc. 1.�lame- (2 rr Title: 4. Date: T `" I.* 4 • 1 . Rom. CHIEF ACCOUNTANT ACCOUNTING DIVISION, FINANCE DEP RIENT' 10. Check Distribution: 12. Approved: • Batch No: DESCRIPTION OF ITEM(S) TO BE PAID 9 i2lair Date FfianoeiCity"Manager Date FN/AC 202 Rev. 06/04 Department: 41. • PvpA Approved: Vendor No: IVH) L 3:2:7gsq ACCOUNT CODE/ :SUBSIDIARY NO. 900% 53Lcii. ,. Expenditure Control FOR FINANCE USE ONLY Check No: FOR REQUESTING DEPARTMENT USE ONLY Pre -encumbered By: Date: Route: White and Canary copes toExpenditure Control and retain Pink copy. Distribution: White and C anary Finance (Accounting) AMOUNT //aoo oo Control Nu er 410 Public Risk Underwriters P. O. Box 958455 Lake Mary, FL 32795-8455 Due Date PREMIUM NOTICE Southeast Overtown Park Community Redevelopment Agency 49 NW 5th Street, Ste. 100 Miami, FL 33128 Transaction Description to of Bill: 5/1/2006 Policy #: 001000000282105 Division: 00000 Policy Year: 105 Amount Due: $ 4,600.00 Due Date: 06/1/2006 06/1/2006 • Previous Billing Payment recd October 21, 2005 Total Amount Due Please make check payable Serviced by: Direct Inquiries to: Agent: 5 .. ' '- $ Amount 10,194.00 5 594.00 4,600.00 Preferred Governmental Insurance Trust Public Risk Underwriters WORK COMP UNIT (321) 832-1450 to: Brown & Brown, Inc. 220 S. Ridgewood Avenue Daytona Beach, FL 32114 (386) 252-9601 Please return copy of Make checks payable to: Preferred SE Overtown Park Community Redev Agency 49 NW 5th Street, Ste. 100 Miami, FL 33128 Public Risk Underwriters P.O. Box 958455 Lake Mary, FL 32795-8455 Teresa Schwab notice with your remittance. Governmental Insurance Trust Date of Bill: 06/01/2006 Policy #: 001000000282105 Division: 00000 Policy Year: 105 Amount Due: $ 4,600.00 Due Date: /06/01/2006 Amt Enclosed: • City of Miami Legislation CRA Resolution: CRA-R-06-0004 City Hall 3500 Pan American Drive Miami, FL 33133 www.ci.miarra.fl.us File Number. 06-00096 Final Action Date: 1/30/2006 A JOINT RESOLUTION OF THE BOARDS OF DIRECTORS OF THE SOUTHEAST OVERTOWN/PARK WEST AND OMNI REDEVELOPMENT DISTRICT COMMUNITY REDEVELOPMENT AGENCIES CCRAS'), RATIFYING THE EXECUTIVE DIRECTOR'S RENEWAL OF THE CRAS' WORKERS' COMPENSATION INSURANCE COVERAGE WITH PREFERRED GOVERNMENTAL INSURANCE TRUST, FOR A PERIOD OF ONE YEAR, COMMENCING OCTOBER 1, 2005, FOR'THE AMOUNT OF $5,594; FUNDS TO BE ALLOCATED FROM GENERAL OPERATING FUND, "INSURANCE LIABILITY," ACCOUNT CODE NO.689004.5J0011.6.650. WHEREAS, the CRAs' existing workers' compensation insurance coverage with Preferred Govemmental Insurance Trust ("PGIr) expired on September 30, 2005; and WHEREAS, to ensure uninterrupted workers' compensation coverage, the Executive Director authorized renewal of coverage with PGIT, for a period of one year, commencing October 1, 2005, for the amount of $5,594; and WHEREAS, the Boards of Directors wish to ratify the Executive Director's renewal of workers' compensation insurance coverage; NOW, THEREFORE, BE IT RESOLVED BY THE BOARDS OF DIRECTORS OF THE SOUTHEAST OVERTOWN/PARK WEST AND THE OMNI REDEVELOPMENT DISTRICT COMMUNITY REDEVELOPMENT AGENCIES OF THE CITY OF MIAMI, FLORIDA: Section 1. The recitals and findings contained in the Preamble to this Resolution are adopted by reference and incorporated herein as if fully set forth in this Section. Section 2. The Executive Directors renewal of the CRAB' workers' compensation insurance coverage with Preferred Governmental Insurance Trust, for a period of one year, commencing October 1, 2005, for the amount of $5,594, is ratified. Section 3. Funds are to be allocated from General Operating Fund, "Insurance Liability," Account Code No. 689004.550011.6.650. Section 4. This Resolution shall become effective immediately upon its adoption. APPROVED AS TO FORM AND CORRECTNESS: JORGE L. FERNANDEZ City dfMiguni Page 1 of 2 Printed On: 4/26/2006 to City of Miami REQUEST FOR DIRECT PAYMENT INSTRUCTION: Please attach all the original documents related to expenditures, i.e., receipts, bills, invoices, etc. ame: FROM � hOrjiC �G- 2 apartment Ass. t��1-046cb— te: ! rrr rave '1 25 , 77 TO CHIEF ACCOUNTANT, ACCOUNTING DIVISION, FINANCE DEPARTMENT J 5. Name: 00 ea fyi a.'", ueunce.. oaf 6. Address: P . 30x 958.455 jck u Tv , -L. 32`795- 5- 5'55 DESCRIPTIO F ITEM(S) TO BE PAID 14Drka,rS C. p. ~\r °.DOS- 20� cQ --Jr P011Q1-tfr 06k clef OD( 2s2f 7. 10. Check Distribution: ❑ytil Direct to Vendor Return to Department 12. A Department Director/Designe Appr 1 - nc= /CI Manager 0 Date /14 *11P5 Date Batch No: Approved: I ACCOUNT CODE/ SUBSIDIARY NO. 6P71. 5W01 ). 6.450 PAID 'HECK# 01MOUNTS5 5Qy DATE 0 `ANAL TOTAL PAYMENT AMOUNT 9115,Sq ° Expenditure Control Date Vendor No: FOR REQUESTING DEPARTMENT USE ONLY Pre -encumbered By: Date: OR FINANCE USE ONL Check No: Date: �� Control Numl C JFN/AC 202 Rev. 12/89 f Route: White and Canary copies to Expenditure Control and retain Pink copy. Distribution: White and nano... _ C; �A___.._,.__, 411 Public Risk Underwriters P.O. Box 958455 Lake Mary, FL 32795-8455 P R EMI`tTM NOT I C E Southeast Overtown Park Community 49 NW 5th Street, Ste. 100 Miami, FL 33128 Due Date Transaction Description Previous Unpaid Balance 10/03/2005 October Billed Premium Expense Constant Due 10/03/2005 Total Amount Due Date of Bill: 10/03/2005 Policy #: 001000000282105 Division: 00000 Policy Year: 105 Amount Due: $ 5,594.00 Due Date: 10/03/2005 Amount $ .00 $ 5,394.00 $ 200.00 $ 5,594.00 Please make checks payable to: Preferred Governmental Insurance Trust Serviced by: Public Risk Underwriters Direct Inquiries to: WORK COMP UNIT Agent: 5 Brown & Brown, Inc. P. O. Box 2412 Daytona Beach, FL 32115 (386) 252-9601 (321) 832-1450 APPROVED Please return copy of Make checks payable to: Preferred Southeast Overtown Park Community 49 NW 5th Street, Ste. 100 Miami, FL 33128 Public Risk Underwriters P.O. Box 958455 Lake Mary, FL 32795-8455 notice with your remittance. Governmental Insurance Trust Date of Bill: 10/03/2005 Policy #: 001000000282105 Division: 00000 Policy Year: 105 Amount Due: $ 5,594.00 Due Date: 10/03/2005 Amt Enclosed: • • ESTIMATEDEILING Preferred Governmental Insurance Trust P.O. Box 958455 Lake Mary, FL 32795-8455 Southeast Overtown Park Community 49 NW 5th Street, Ste. 100 Miami, FL 33128 Print Date: Policy #: Division: Policy Period: 8/30/2005 001000000282105 00000 10/01/2005-10/01/2006 Agent #: 5 Brown & Brown, Inc. P. 0. Box 2412 Daytona Beach, FL 32115 (386) 252-9601 Rating State: FL Code Classification Payroll Rate Premium 5645 CARPENTRY CONSTRUCT 8810 CLERICAL Standard liability limits: 1000/1000/1000 Serviced by: :Public Risk Underwriters P.D. Box 958455 Lake Mary, FL 32795-8455 38.40 566,937 .64 Phn# (321) 832-1450 0 3,628 LESTERP Page 1 • • ESTIMATED BILLING Preferred Governmental Insurance Trust P.O. Box 958455 Lake Mary, FL 32795-8455 Southeast Overtown.Park Community 49 NW 5th Street, Ste. 100 Miami, FL 33128 Manual Premium Print Date: Policy #; Division: Policy Period: 8/30/2005 001000000282105 10/01/2005-10/01/2006 Agent #: 5 Brown & Brown, Inc. P. O. Box 2412 Daytona Beach, FL 32115 (386) 252-9601 Subject Premium Experience Modifier Standard Premium Stock Discount Normal Premium Expense Constant Estimated Premium Premium Eff Date Lacy Date 1.0000 0.88% 3,628.00 3,628.00 3,628.00 1,814.00+ 5,442.00 48.00- 5,394.00 200.00+ 5,594.00 Expense Constant Premium Paid Balance Payment Plan: 25% DOWN Due October 1, 2005 Due November 1, 2005 Due December 1, 2005 Due January 1, 2006 :Due February 1, 2006 Due March 1, 2006 Due April 1, 2006 Due May 1, 2006 Due June 1, 2006 Due July 1, 2006 5,394.00 200.00 .00 Experience Modifiers: 1.0000 5/01/2005 *5,594.00 9 EQUAL INSTALLMENTS 1,548.50 449.50 449.50 449.50 449.50 449.50 449.50 449.50 449.50 449.50 Make checks payable to Preferred Governmental Insuran Page 2 ti • ESTIMATED B I L L I N G Preferred Governmental Insurance Trust Print Date: P.O. Box 958455 Policy8/30/2005 Lake Mazy, FL 32795-8455 Division: 0000001000000200000 Policy Period: 10/01/2005-10/01/2006 Agent #: 5 Brown & Brown, Inc. Southeast bverton Park Conmmnit P. O. Box 2412 49 VW 5th Street, Ste. 100 Y DaytonaBeach, FL 32115 Miami, FL 33128 (386) 252-9601 Code Classification 5645 CARPENTRY CONSTRUCT 8810 CLERICAL dard liabilit limits: 1000 1000 1000 Serviced by: Public Risk Underwriters P.O. Box 958455 Lake Mary, FL 32795-8455 Rating State: FL Payroll 566,937 Phn# (321) 832-1450 LESTERP Page 1 'ESTIMATEDBILLING • Preferred Governmental Insurance Trust P.O. Box 958455 Lake Mary, FL 3 279 5 - 8455 Southeast Overtown Park Community 49 NW 5th Street, Ste. 100 Miami, FL 33128 Manual Premium Print Date: Policy #: Division: Policy Period: 8/30/2005 001000000282105 00000 10/D1/2005-10/01/2006 Agent #: 5 Brown & Brown, Inc P. O. Box 2412 Daytona Beach, FL 32115 (386) 252-9601 Subject Premium Experience Modifier Premium 1.0000 200.00+ 5,594.00 Expense Constant Premium Paid. Balance 5,394.00 200.00 .00 $5,.594.00 Experience Modifiers: 1.0000 5/01/2005 Payment Plan: 25% DOWN 9 EQUAL 1NSTT LLMENTS Due October 1, 2005 1,548.50 Due November 1, 2005 449.50 Due December 1, 2005 449.50 Due January 1, 2006 449.50 Due February 1, 2006 449.50 Due March 1., 2006 449.50 Due April 1, 2006 449.50 Due May 1, 2006 449.50 Due June 1, 2006 449.50 Due July 1, 2006 449..50 Make checks payable to Preferred Governmental Insuran Page 2