HomeMy WebLinkAboutCRA-R-11-0049 10-24-2011 BackupSUPPORTING
DOCUMENTATION
Preferred
GOVERNMENTAL
INSURANCE TRUST
WORKERS COMPENSATION AND LOVERS LIABILITY
COVERAGE AGREEMENT ENDORSEMENT
SCHEDULE OF OPERATIONS
Named Covered Party:
Southeast Overtown Park Community Redevelopment Agency
49 NW 6th Street, Suite 100
Miami, FL.33128
Agreement No,: WC2FL1 0134004 10-07
Fein
1945495
nvolce Numb
overage Term• 10/01/2011 - 10/01/2012
Coverage Provider Preferred Governmental Insurance Tru
arrier No,
38849
Manual Premium
Deductible/Coinsurance
Safety Program
Drug Free Workplace
Experience Modification - Listed Below
Schedule Adjustment
Standard Premium
Premium Discount
Normal Premium
Expense Constant
Annual Premium
Experience Modifiers 1.000000 10/01/2011
0,00%
$8,077
$0
$0
$0
$8,077
$0
$8,077
$0
$8,077
$200
$8,277
/
'
Preferred Governm
Coverage Agreem
Endorsement No.: I
Southeast Dv �ownPa�
Member:a
Community Redevelopment
Agency
coverage Period: 1001/2010ho 1001/2012
SUPPORTING
nt Endorsement
Effective Date: 10O1/2O11
Agreement No.:VVC2FL1 013400410'07
`
Second annual Installment is $0/277.00 which will be invoiced based on current installment plan,
C��|
Workersomnm�nm on
The Coverage Agreement utilized the Experience Mod of 1.00 for 2011, which remained the same as 2010,
The revised rating wmrkoheet|aattached.
Subject otherwise to the terms, conditions and exclusions ofthe coverage agreement.
Issued: 08/10/2011 Authorized by:
9.
'
Endorsement No.;
Member:
Coverage Period;
Preferred Governmental In
Coverage Agreement Endorsemen
2 Effective Date; 10/D1/2O11
Southeast Oxedown0ParkWest, Agreement No.: PK2FL1 0134033 10-08
Omn|&Midtown Community
Redevelopment Agencies
Premium for Second Annual Installment: *43,160
propodVVncJudinoProvedvExtensions)
Coverage iaconfirmed asbeing per the attached updated Property Schedule.
CurnantT|V
Buildings: $450.000
Contents: $iG5.00O
Total: $615.000
Pr000rtv'Inland Marine
Coverage is confirmed as being per the attached updated Inland Marine schedule,
Current Inland Marine T|V
Total: $74,708
EffenUve1O10M12011:
The coverage agreement is amended with the following enhancements per the liberalization clause on PGIT
UQO.Changes include, but are not limited to:
PQ[T1D4,Section N|.Item 8isdeleted entirely and replaced with:
Q. Errors and Omissions
It is material requirementofthisognuementthattheOovoredPertyoccunateyreportthevolu000fthw
property for which it seeks coverage at the locations within the Coverage Agreement territory where that
property |nlocated. Subject bzthis requirement, wewill not preclude coverage for damage ota
particular location where the Covered Party or its producer made an error or unintentional omission:
1. |nthe description orlocation ofihum( ) of property|nthe most recent Schedule of
DECLARATIONS or documentation submitted to and accepted by um, provided that the |hsm is
the type covered under the Coverage Agreement and the error or omission is not greater than
the limit set forth in the Declarations.
2. In the Schedule of DECLARATIONS so that the report omitted a location owned or occupied
bythe Named Covered Party o\the inception date
Any such error or unintentional omission shall be reported promptly on discovery and additional
premium paid from Coverage Agreement inception, The limit shown |nthe Declarations \othe maximum
amount ofindemnity for any occurrence. This coverage does not apply |fcoverage |ofound inwhole or
\npart elsewhere inthis agreement.
PG|T1&4, GecUonV1||. Item 0,5 is deleted entirely and replaced with:
6. Fine Arts -Ynurah, acu|ptures, roddoa, or antiquities, owned by you or in your uena.
custody and control,
`
Endorsement No.: 2
0)omber. 8outhaostOvartownKPerk West, Agreement No.;Pl 013403310'03
Omni & Midtown Community
Redevelopment Agencies
SUPPORTING
DOCUMENTATION
/
Preferred Governmental Insurance l��Coverage Agreement Endorsement
Effective Date; 10/01/2011
p8|T20].Section U.Item D.3isdeleted entirely and replaced with:
8. Your authorized volunteer or /eooad employee who one deemed as your agent, but only while
under your supervision and |nthe course and scope ofwork approved byyou,
Other lines of coveracie remain unchanqed.
Subject otherwise to the terms, conditions and exclusions of the coverage agreement.
/ Issued: 0807/ U11 Authorized by:
~