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Home My WebLink AboutCRA-R-11-0055 10-24-2011 BackupPre erred GOVERNMENTAL INSURANCETRUST PGIT WORKERS COMPENSATION AND EMPLOYER COVERAGE AGREEMENT ENDORSEM SCHEDULE OF OPERATIONS TING L9294.4ENTATION Named Covered Party: Southeast Overtown Park Community Redevelopment Agency 49 NW 5th Street, Suite 100 Miami, FL 33128 Agreement No,: WC2FL1 0134004 10-07 Fein: 65-0945495 Invoice Number: Coverage Term: 10/01/2011 - 10/01/2012 coverage Provider Preferred Governmental Insurance Trust Carrier 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 Governmental Insurance Tr Coverage Agreement Endorsement Endorsement No.: 1 Member: Southeast Overtown Park Community Redevelopment Agency Coverage Period: 10/01/2010 to 10/01/2012 Effective Date:10/01/2011 Agreement No.: WC2FL1 0134004 10-07 Second annual Installment Is $8,277.00 which will be invoiced based on current installment plan. Workers Compensation The Coverage Agreement utilized the Experience Mod of 1.00 for 2011, which remained the same as 2010. The revised rating worksheet is attached. Subject otherwise to the terms, conditions and exclusions of the coverage agreement. Issued: 08/10/2011 Authorized by: 141) Nt.. Preferred Governor - - : nce Trust Coverage Agreement Endorsement Endorsement No.; 2 Member: Southeast Overtown/Park West, Agreement No.: PK2FL1 0134033 10-03 Omni & Midtown Community Redevelopment Agencies Coverage Period: 10/01/2010 to 10/01/2012 Effective Date: 10/01/2011 Premium for Second Annual Installment: $13,169 Property (including Property Extensions) Coverage is confirmed as being per the attached updated Property Schedule. Current TIV Buildings: $ 450,000 Contents: $ 165,000 Total: $ 615,000 Property - Inland Marine Coverage is confirmed as being per the attached updated Inland Marine schedule. Current Inland Marine TIV Total: $74,708 Effective 10/01/2011: The coverage agreement is amended with the following enhancements per the liberalization clause on PGIT 090, Changes include, but are not limited to: PGIT 104, Section VII, Item G is deleted entirely and replaced with: G. Errors and Omissions It is a material requirement of this agreement that the Covered Party accurately report the values of the property for which it seeks coverage at the locations within the Coverage Agreement territory where that property is located. Subject to this requirement, we will not preclude coverage for damage at a particular location where the Covered Party or its producer made an error or unintentional omission:' 1. In the description or location of item(s) of property In the most recent Schedule of DECLARATIONS or documentation submitted to and accepted by us, provided that the item 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 by. the Named Covered Party at 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 in the Declarations is the maximum amount of indemnity for any occurrence. This coverage does not apply if coverage Is found in whole or in part elsewhere in this agreement. PGIT 104, Section VIII, Item 0,5 is deleted entirely and replaced with: 5, Fine Arts - Your art, sculptures, rarities, or antiquities, owned by you or In your care, custody and control. SUPPORTING DOCUMENTATION Preferred Gover urance Trust overage Agreement Endorsement Endorsement No.: 2 Member: Southeast Overtown/Park West, Omni & Midtown Community Redevelopment Agencies , IA Effective Date: 10/01/2011 Agreement No.: Pk2FL1 0134033 10-03 PGIT 200, Section II, Item 0,3 is deleted entirely and replaced with: 3, Your authorized volunteer or leased employee who are deemed as your agent, but only while under your supervision and in the course and scope of work approved by you, Other lines of coverage remain unchanged. Subject otherwise to the terms, conditions and exclusions of the coverage agreement. Issued: 09/07/2011 Authorized by: 4"1""" °""""