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HomeMy WebLinkAboutCRA-R-07-0029 Back-upLa-GUcaryr� ACO4O 925 t7198j F.S+- 'P MLETE REVERSE SIi L Brown & Brown of Florida, Inc. 220 South Ridgewood Avenue (32114) P.O. Box 2412 • Daytona Beach, FL 32115 386/252-9601 • FAX 386/239-5729 CO HI. NE. Or311.1A10., 2fla7 . CITY OF MIAMI CRA MIGIJEL VALENTIN 49 NW 5TH ST SUITE 100 MIAMI, FL 33128 RE: Proposal Letter COMMERCIAL PACKAGE Policy Term: 06/23/07- 06/23/08 Dear Miguel: We are pleased to offer the following insurance terms. Higher limits may be available; please fet us know if you would like to receive a proposal for higher limits. Coverage: Commercial Package Perils: Occurrence Form Basic Form Excluding Wind, Hail, Quake, Flood, Theft Limits: $3,000,000 Excludes Excludes $3, 000, 000 $ 50,000 $ 1,000 $ 130,000 $ 20,000 90% Coinsurance Deductibles: General Liability: Property General Aggregate Products/Completed Operations Personal & Advertising Injury Each Occurrence Fire Damage Medical Expense Business Personal Property Business Income without Extra Expense Except'/, Monthly Limitation on Business Income $1,000 Business Income/ Property/Damage/ Personal Injury & Advertising Injury Per Claim Including Loss Adjustment Expense $1,000 All Other Perils Deductible Excluding Wind, Hail, Theft PP � rown II rown INSURANCE Brown & Brown of Florida, Inc. 220 South Ridgewood Avenue (32114) P.O. Box 2412 ■ Daytona Beach, FL 32115 386/252-9601 ■ FAX 386/239-5729 Forms and Endorsements Listed Below But Not Limited To: 0111054 Service of Suit, Common Policy Conditions, Nuclear Energy Liability Exclusion, Privacy Notice CP0010 Building and Personal Property Coverage Form CP0090 Commercial Property Conditions CP0125 Florida Changes M/E-143 Minimum Earned Premium Amendment CG0001 Commercial General Liability Coverage Form CG0220 Florida Changes —Cancellation and Nonrenewal M/E-048 Deductible Liability M/E-001 Combination Endorsement —Duty To Defend; Employers' Liability Exclusion Amended; Auto, Aircraft & Watercraft Exclusion Amended; Exclusions: Punitive or Exemplary Damage; Discrimination; Employment Related Practices; Errors, Omissions, Negligent Acts, Professional Liability; Malpractice; Animals; Breach of Contract; Assault & Battery; Sports or Athletics; Cross Suits Liability; Intellectual Property; Telephone; 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 Insured; Supplementary Payments —Coverage A & B; Insured Contract; Lessor's Risk Only Classification MiE-002 Additional Conditions Endorsement —Subsidence Exclusion; Pollution Exclusion; Asbestos, Lead, Silica, Dust, Fungi, Bacteria Exclusion; Contractor's Limitation 011-1096 Terrorism Exclusion CG2169 War or Terrorism Exclusion MKL TERR3 Notice of Terrorism Insurance Coverage —Form Must be signed MUST ELECT OR REJECT COVERAGE ME009 Additional Insured Endorsement ME217 Limitation of Coverage to Designated Premises ME159 Exclusion__Personal & Advertising Injury ME173 Exclusion —Products & Completed Operations CP1030 Cause of Loss Special Form CP1033 Theft Exclusion CP1054 Windstorm & Hail Exclusion --Form Must be signed CP0032 Business income Without Extra Expense JGF9 Protective Safeguards-100% Sprinkler System Optional Coverage: IMPORTANT NOTICE REGARDING FEDERAL TERRORISM ACT OF 2002: You are hereby notified that under The Terrorism Risk insurance Act of 2002 the Brown & Brown of Florida, Inc. 220 South Ridgewood Avenue (32114) P.O. Box 2412 ■ Daytona Beach, FL 32115 386/252-9601 ■ FAX 386/239-5729 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 MKL TERR 3 (12/19/02) form signed by the policyholder. iF THE TERRORISM COVERAGE IS PURCHASED, THE COVERAGE CANNOT BE CANCELLED MID-TERM UNLESS THE ENTIRE POLICY IS CANCELLED. Subject to: Completed original application signed by insured Premium is 25% minimum earned if canceled by insured Premium is minimum & Deposit, subject to Audit AB policy fees and inspections fees are fully earned and non-refundable Must have signed application and Terrorism forms signed in order to bind Premium: $8,025.00 Policy Fee: $ 35.00 FL Catastrophe Fee: $ 4.00 CPIC Assessment Fee: $ 806.00 Fees: $ 845.00 Total: $8, 870.00 Please review and let us know if you have any questions or if you would like to accept this proposal. incerely, Ara Morales Account Manager MIAMI 9 / ER ..JRD COMMERCIAL INSURANCE APPLICATION APPLICANT INFORMATION SECTION re -ER I I {NNO No, Ext): 386-252-9601 [GERCY CUSTOMER ID IAMI-9 Brown & Brown Daytona Beach P.O, Box 2412 Daytona Beach Steve Farmer ODE: 386-239-5729 of Florida, Inc. Office FL 32115-2412 STATUS OF SUBMISSION X SUB CODE: QUOTE Li ISSUE POLICY BOUND (Give Dale and/or Attach Copy): TIME DATE APPLICANT INFORMATION AM PM CARRIER I NAIC CODE: Essex Insurance Co POLICIES OR PROGRAM REQUESTED COMMERCIAL PACKAGE INDICATE SECTIONS ATTACHED X X PROPERTY GLASS AND SIGN ACCOUNTS RECEIVABLE) VALUABLE PAPERS CRIMl=IMISCELLANEOUS CRIME MOTOR TRUCK TRANSPORTATION!! PACKAGE POLICY INFORMATION (1P in A UNDERWRITER EOUIPMENT FLOATER INSTALLATION/BUILDERS RISK ELECTRONIC DATA PROC X COMMERCIALNIILITY BUSINESS AUTO TRUCKERS/MOTOR CARRIER DATE 06/14 07 GARAGE AND DEALERS VEHICLE SCHEDULE BOILER 8 MACHINERY WORKERS COMPENSATION UMBRELLA ENTER THIS INFORMATION WHEN COMMON DATES AND TERMS APPLY TO SEVERAL LINES, OR FOR MONOLtNE POLICIES. PROPOSED EFF DATE PROPOSED EXP DATE 8ILLING PLAN 06/23/07 06/23/08 DIRECT BILL X AGENCY BILL PAYMENT PLAN AUDIT NAME (First Named Insured 8 Other Named Insureds) CITY OF MIAMI SOUTHEAST OVERTOWN PARK WEST CRA INDIVIDUAL PARTNERSHIP INSPECTION CONTACT CORPORATION JOINT VENTURE JJIM VILLACORTA PREMISES INFORMATION LOC# BLD;r 1 2 1 PHONE (AIC, No, Ext): h[:IN UH'UL Sttf (of First Named Ins): PHONE (AfC, No, Ext); SUBCHAPTER "S" CORPORATION LIMITED CORPORATION 305-679-6800 ___/ PRCRAU jOFTDRGNAME 305-679-6807 STREET, CITY, COUNTY, STATE, ZIP+4 49 NW 5TH ST SUITE 100 Nam' FL 33128 DADE 45 NE 10TH ST MIAMI FL 33128 DADE NATURE OF BUSINESSIDESCRIPTION OF OPERATIONS BY PREMISE(S) 1 1 RESIDENTIAL AND COMMERCIAL ACTIVITY IN THE BLIGHTED AREA, SPUR THE DEVELOPMENT & REDEVELOPMENT OF PRIME REAL ESTATE FOR NEW 2 1 MAILING ADDRESS 1NCL ZIPs4 (of First Named Insured) 49 NW 5TH ST SUITE 100 MIAMI FL 33128 YEAR BUS STARTED ISAME ACCOUNTINGRECORDSCONTACT I PHONE 1982 (A)C, Na, Ext): CREDIT BUREAU ID NUMBER (See page 3 for business type other description.) CITY LIMITS X I INSIDE 1 OUTSIDE X INSIDE OUTSIDE INSIDE OUTSIDE X X INTEREST 1 YR BUILT OWNER TENANT OWNER TENANT OWNER TENANT PART OCCUPIED PART NONE GENERAL INFORMATION EXPLAIN ALL "YES" RESPONSES I. IS THE APPLICANTA SUBSIDIARY OF ANOTHER ENTITY OR DOES THE APPLICANT HAVE ANY SUBSIDIARIES? 2, IS A FORMAL SAFETY PROGRAM IN OPERATION? 3. ANY EXPOSURE TO FLAMMABLES, EXPLOSIVES, CHEMICALS? 4 ANY CATASTROPHE EXPOSURE? 5. ANY OTHER INSURANCE WITH THIS COMPANY OR BEING SUBMITTED? B. ANY POLICY OR COVERAGE DECLINED CANCELLED OR NON -RENEWED DURING THE PRIOR 3 YEARS? NOT APPLICABLE IN MO REMARKS YES NO x X x x X X ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR ANOTHER PERSON FILES AN APPLICATION FOR INSURANCE OR STATEMENT OF CLAIM CONTAINING ANY MATERIALLY FALSE INFORMATION, OR CONCEALS FOR THE PURPOSE OF MISLEADING, INFORMATION CONCERNING ANY FACT MATERIAL THERETO COMMITS A FRAUDULENT INSURANCE ACT, WHICH IS A CRIME AND SUBJECTS THE PERSON TO CRIMINAL AND NY; SUBSTANTIAL] CIVIL PENALTIES. (NOT APPLICABLE IN CO, HI, NE, OH, OK, OR; IN ME AND VA, INSURANCE BENEFITS MAY ALSO BE DENIED) APPLICANTS SIGNATURE ACOR�S (7198) PLEASE COMPLETE REVERSE SIDE EXPLAIN ALL -YES' RESPONSES 7. ANY PAST MOLES ATION ALLEGATIONS, DISCRIMINATIONEOR NEGLIGENT R HIRING? 8. DURING THE LAST TEN YEARS, HAS ANY APPLICANT BEEN CONVICTED OF ANY DEGREE OF THE CRIME OF ARSON? (In RI, this queslian mull be answerse the ewe once of an applicant conviction sya misdemeanor punishable by a sentence of up to one year of Imprisonment). B. ANY UNCORRECTED FIRE COOE VIOLATIONS? 10 ANY BANKRUPTCIES TAX OR CREDIT LIENS AGAINST THE APPLICANT IN THE PAST 5 YEARS? SIGNATURES Steve Farmer YES( NO ©ACORD CORPORATION 1993 X X X X i II 1 Brown & Brown of Florida, Inc. 220 South Ridgewood Avenue (32114) P.O. Box 2412 • Daytona Beach, FL 32115 386/252-9601 • FAX 386/239-5729 June 13, 2007 CITY OF MIAMI CRA EVA KILPATRICK 49 NW 5TH ST SUITE 100 MIAMI, FL 33128 RE: Proposal Letter INLAND MARINE Policy Term: 06/23/06 to 06/23/07 Dear Eva: We are pleased to offer the following insurance terms. Higher limits may be available; please let us know if you would like to receive a proposal for higher limits. Coverage; inland Marine Perils: Miscellaneous Property Floater Limits: $56,479 Scheduled Equipment 100% Coinsurance Deductibles: $1,000 Per Occurrence Except 3% Wind & Hail Deductible Subject To A $2,500 Minimum Wind & Hail Deductible Valuation: Actual Cash Value Forms and Endorsements Listed Below But Not Limited To: IMB-MPFAR Miscellaneous Property Floater IMB-PPE Property Pollution Exclusion IMB-011-1097 Organic Pathogen Exclusion IMB-0935 Y2K Exclusion IM-MEP Minimum Earned Premium Endorsement 011-1095 Privacy Notice TER Terrorism Exclusion IMB-TOTLESS IMB-TL MKL TERR 3 Brown & Brown of Florida, Inc. 220 South Ridgewood Avenue (32114) P.O. Box 24/2 ■ Daytona Beach, FL 32115 386/252-960I • FAX 386/239-5729 Total Loss Endorsement Theft Limitation Warranty —Theft Exclusion on Laptops Away From Premises Notice Of Terrorism Insurance Coverage —Form Must be signed Optional Coverages: 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 to 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. IF THE TERRORISM COVERAGE IS PURCHASED, THE COVERAGE CANNOT BE CANCELLED MID-TERM UNLESS THE ENTIRE POLICY iS CANCELLED. Subject To: Completed original application signed by insured Premium is 100% minimum earned if canceled by insured Premium is minimum & deposit, subject to Audit All policy fees and inspection fees are fully earned and non refundable Must have signed application, signed TRJA form in order to bind coverage Premium: $1, 000.00 Policy Fee—XCA: $ 35.00 FL Catastrophe Fee: $ 4.00 Total: $1,039,00 Please review and let us know if you have any questions or if you would like to accept this proposal. incerelyhiuu Ara Morales Account Manager MIAMI-9 / ER APPLICANT INFORMATION NAME (First Named rnsured a Other Named Insureds) CITY OF MIAMI SOUTHEAST OVERTOWN PARK WEST CRA INDIVIDUAL PARTNERSHIP INSPECTION CONTACT JZM VILLACORTE CORPORATION JOINT VENTURE PREMISES INFORMATION COMMERCIAL INSURANCE APPLICATION ORD APPLICANT INFORMATION SECTION AtC No Ext: 386-252_9601 FAX wn & Brown ytona Beach O. Box 2412 aytona Beach Pi 32115-2412 Steve Farmer AGENCY CUSTOMER iD MIAMI-9 STATUS OF SUBMISSION QUOTE ISSUE POLICY BOUND (Give Date and/or Attach Copy)* DATE TIME AM PM SUB CODE: CARRIER NAIC CODE. Essex Insurance Co FOLIC/ES OR PROGRAM REQUESTED INLAND MARINE PROPERTY GLASS AND SIGN ACCOUNTS RECEIVABLE/ VALUABLE PAPERS CRIME)MISCELLANEOUS CRIME TRANSPORTATION/ McTa. PACKAGE POLICY INFORMATION EQUIPMENT FLOATER INSTALLATION/BUILDERS RISK ELECTRONIC DATA PROC COMMERCI GENERAL LABILITY BUSINESS AUTO TRUCKERS/MOTOR CARRIER DATE 06 14 07 GARAGE AND DEALERS VEHICLE SCHEDULE BOILER 5 MACHINERY WORKERS COMPENSATION UMBRELLA ENTER THIS INFORMATION WHEN COMMON DATES AND TERMS APPLY TO SEVERAL LINES, OR FOR MONOLINE POLICIES. PROPOSED EFF DATE PROPOSED EXP DATE BILLING PLAN 06/23/07 T FOR PROFIT ORG A/C, No Fxt : 305-679-6807 STREET, CITY, COUNTY, STATE, ZrP+4 06/23/08 DIRECT BILL AGENCY BILL MAILING ADDRESS INCL ZIP+4 (of First Named Insured) EVA KILPATRICK 49 NW 5TH ST SUITE 100 MIAMI FL 33129 CREDIT BUREAU ID NUMBER (See page 3 for bLsIness type other description.) ACCOUNTING RECORDS CONTACT NE AiG, No, Exl SAME INSIDE OUTSIDE INSIDE OUTSIDE INSIDE OUTSIDE ■ OWNER TENANT OWNER TENANT OWNER TENANT NATURE OF BUSINESS/DESCRIPTION OF OPERATIONS BY PREMISE(S) ■ �� 1 SPUR THE DEVELOPMENT & RECEVELQ PRIME FOR NEWRESIDENTIAL AND COMMERCIAL ACTIVYINTHE BLIG AEA GENERAL INFORMATION EXPLAIN ALL 'YES" RESPONSES THE APPLICANT HAVLI AN E ANY SUBSIDIARIES? HER ENT/ - r 2. ISA FORMAL SAFETY PROGRAM IN OPERATION? 3. ANY EXPOSURE TO FLAMMABLES, EXPLOSIVES, CHEMICALS? 4. ANY CATASTROPHE EXPOSURE? 5. ANY OTHER INSURANCE WITH THIS COMPANY OR BEING SUBMITTED? 6. A YP+Li, — r rANCEF IN MO LLE•s •' O .. s W r P FRSON W1{O ).44IGLY AND WITH INI I FILES AN�} t eLIGATION FOR IN SUR, i FALSE INFORMATION OR CONCEALS FOR T� ANY FACT MATERIAL HERETO COMMITS, • E SUB:,Tm3.:Ec1.:c. THE PERSON TO CRIMINAL AND / r.-'J ' r aE_ , .-iv.:ryq. Il+i MF ANIS VA, INSII n EXPLAIN ALL "YES" RESPONSES • Y PAST L.S S 0 LAI RELATING " 0 ' L ..tLi FOR MOLESTATION ALLEGATIONS, DISCRIMINATION OR NEGLIGENT HIRING? B. DURING THE LAST TEN YEARS, HAS ANY APPLICANT BEEN CONVICTED OF ANY DEGREE OF THE CRIME OF ARSON? Ne RI, Ihla question mast be answered by any epplieanl for property insurance. Failure to disclose the existence of an arson conviction is a misdemeanor punishable by a sentence of up to one year or imprisenmentj. PART OCCUPIED 9. ANY UNCORRECTED FIRE CODE VIOLATIONS, 1. IiNV BANKRI ' -E; -AR RE I TO .DEFRAUD ANY I NCO CO ..E cA.T+ M CLAIM COWrt. NG, INFORM! • T H lSU :'ACT WHICH 'rVTIAI . :MAL TIES. N "iT . v1CV. `;3 .)ENor of res Steve Farmer THE AP N Aav OR /', WTHE ru L rnl�lr': ffR�/IA r� r T P11`' !NUT