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City of Miami
REQUEST FOR DIRECT PAYMENT.
INSTRUCTION: Please attach ail the original documents related to expenditures, i.e., receipts, bills, invoices, etc.
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Title: 4. Date:
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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:
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6. Address:
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10. Check Distribution:
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Return to Department
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Department Director/Designe
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0
Date
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Date
Batch No:
Approved:
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ACCOUNT CODE/
SUBSIDIARY NO.
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6.450
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DATE 0
`ANAL
TOTAL
PAYMENT
AMOUNT
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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