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Res No 116-12-13673RESOLUTION NO. 1 1 6 -1 2 -1 3 6 7 3 A Resolution authorizing the City Manager to permit Larkin Community Hospital to hold a Health Fair on Saturday, June 23, 2012, and closing down SW 70TH Street and SW 61 Court between SW 62 Avenue and SW 61 Avenue for the event. WHEREAS, Larkin Community Hospital submitted a Special Event application requesting permission to hold its event, a Health Fair on Saturday, June 23, 2012, on SW 701h Street and SW 61 Court; and, WHEREAS, for the past 33 years Larkin Community Hospital has provided health initiatives for the patients and residents of the City of South Miami; and, WHEREAS, the applicant has requested permission to hold its event on Sunday, June 23, 2012; and, WHEREAS, the applicant paid $2,812.84 for the deposit ($600.00), application fee ($60.00), Public Works ($602.84), Police ($960.00), Street Closure ($450.00), (1055 linear feet X,25 = $250.00 + $200.00 MOT), and Parking Meter ($800.00), (32 meters X $25.00 per day per meters). NOW, THEREFORE, BE IT RESOLVED BY THE MAYOR AND CITY COMMISSION OF THE CITY OF SOUTH MIAMI, FLORIDA: Section 1. The City Manager is authorized to approve the Larkin Community Hospital Health Fair event to be held on Sunday, June 23rd, 2012, to allow street closure of SW 70th Street and SW 61 Court, between SW 62 Avenue and SW 61 Avenue for the event. Section 2. Payment of $2,812.84 for this special event was paid. Section 3. If any section clause, sentence, or phrase of this resolution is for any reason held invalid or unconstitutional by a court of competent jurisdiction, the holding shall not affect the validity of the remaining portions of this resolution. Section 4. This resolution shall become effective immediately upon adoption by vote of the City Commission, PASSED AND ADOPTED this 5 th day of June 52012, T EST: APxMiL A : =, T CI 'Y CLERK YMAYOR READ AN ROVED AS TaXORM, COMMISSION VOTE: 5 -0 LAN, E, LEGALITW#qD J Mayor Stoddard: Yea EX U I NTH R Vice Mayor Liebman: Yea Commissioner Newman: Yea Commissioner Harris: Yea CITY ATTORNEY Vf Commissioner Welsh: Yea Page 1 of 1 South Miami CITY OF SOUTH MIAMI Ali•AmericaCRY OFFICE OF THE CITY MANAGER r INTER- OFFICE MEMORANDUM 2001 To: The Honorable Mayor & Members of the City Commission Via: Hector Mirabile, PhD, City Manager Via: Carmen Baker, Chief Coordinating Officer /Code Enforcemen Pie rtor From: Maria E. Stout -Tate, Special Events Coordinator rQA Date: May 16, 2012 Agenda Item No.: Subject: A Resolution authorizing the City Manager to permit Larkin Community Hospital to hold a Health Fair on Saturday, June 23, 2012, and closing down SW 70th Street and SW 61 Court, between SW 62 Avenue and SW 61 Avenue for the event. Background: Larkin Community Hospital submitted a Special Event application requesting permission to hold its event, a Health Fair, on Saturday, June 23, 2012, on SW 70 Street and SW 61 Court. For the past 33 years, Larkin Community Hospital has provided health initiatives for their patients and residents of the City of South Miami. According to the applicant, this event will draw approximately 300 spectators, and would be the first of many more to come. There will be a live jazz band, radio broadcasting by three (3) different stations, and food vendors. The hospital will provide free blood pressure, glucose, cholesterol, lead and BMI testing, along with providing information on alcohol and drug abuse. The applicant paid $2,812.84 for the deposit ($600), and application fee ($60.00), Police ($960.00),(2 officers, 12 hrs. X $40.00 per hr), Public Works ($602.84), (Two employees), Street closure & MOT, ($450.00),(Street closure $250.00, MOT $200.00), Parking Meters($ 800.00), (32 meters X $25.00 per day). Expense: $25812.84 is 2 /0 : 30d0" Account: Not Applicable Attachments: proposed Resolution JNIMARY OF EVEN This section of the permit application is intended to provide'the Special Events Permit Committee with an overview of your event. Information you provide in this section is public information and may be used in developing the City of South Miami's Calendar of Special Events. Application must be submitted no less than twenty -one (21) days prior to the effective date of the event with all required documents. TYPE OF EVENT NAME OF EVENT: C] Filming [] Charity [] Festivals (] Celebration [❑ Promotion LOCATION OF EVENT on I I Other: H eo h -fo I (2L rnoU ) (Please note: write complete mailing address, as well as name of any buildings and /or parks if applicable) Is this an annual event? gNo Yes if yes, this is the annual event, previous date EVENT DATE(S): (� Ic� EVENT DAY(S): __ < f l.tQ C�►Gt ACTUAL EVENT HOURS: 10 0 (ag/p.m. UNTIL: � = � a.m. (Please note: event may not begin earlier then 8 a.m. or end later then 11 p.m. in residential areas, or midnight in commercial areas) ASSEMBLY DATE(S): �c�' la SETUPIDOWN TIMES: S a.m p.m._ a.m fp.m ANTICIPATED ATTENDANCE: E;2 TOTAL EVENT DURATION: Ch Drs miss Name: , JC�� Title: I ' 0( Q Cell /Phone: Email:, 1 nlJ ("Q Lo Name: itle: Cell /Ph •GD4 ail: C.cmil 1 � Q 1A6 J APPLIC ANUSPONSOR INFORMATION The applicant for the Special Event Permit must be the authorized representative of the organization /business conducting the special event. This person must be available to work with the City's Special Event Permit Committee throughout the permitting process. A professional event organizer, or other representative, may apply for the Special Event permit on behalf of the organization /business. NAME OF ORGANIZATION: ADDRESS OF ORGANIZATION: Lin CoYlmun I 90 A X1413 L OFFICE TELEPHONE: �����.� FAX: �5� — �i PRESIDENT• O - aaECRETARY: &Jpao �� C�O ADDRESS: mial� PRES. PHONE: �� " EMAIL: ,- SEC. PHONE: C J �-� CO1 EMAIL: �oi Event Name: N O11 CATION I PETI rION t laSp c Event Date: '6 (ze)llz We, the undersigned businesses and /or residents, have been notified of street closures associated with the event noted about on said date, and hereby agree or disagree to the closure(s). We are also aware that this response may not effect this application being approved or disapproved. NIB +.. t , 4F �� ���� I . �4{+'� .1' 1, y � !T4V../Lt{{.... ��rr a �1 :ti. �� ' Ll� � � r O d� � _ r4 ..M i ` L. • ft ��� [O, •.� k` �,i . y'J rn 'q � I w� SU5 ' (OCO / ' CDq A roved Disa roved El pp pp C mss- (40(40 3 - O �J Approved ❑ �j � Disapproved toLn kliGn1 i-�I- � 6 !u 305 - t�tgZ• 3�v1 � l �. t-� i CcZ ►0 (Q.l4t ��-1� .. Z• WA MI Approved Disapproved ❑ ran •ern+ z rJt� 51 sW CoaAr� . �3as��ec�1 c �71: A tJ Disapproved ❑ Gutti�- , �'`zj M i urn ►'L. 3 3� y C3as�t� U -a pproved Approved 0 Disapproved ❑ Approved ❑ Disapproved ❑ Approved El Disapproved ❑ Approved ❑ Disapproved ❑ Approved 0 Disapproved ❑ Approved ❑ Disapproved ❑ 6 -16 lip No OL THIS AGREEMENT ( "Agreement ") is entered into by and between ("Applicant") and the City of South Miami ( "City ") on the date on wl RECITA)I:.S WHEREAS, the Applicant has submitted a Special Event Permit Application to the City for (event Lc L to Ca"Unt A r l I -6:01 -hi nip go 01 S4. (f-on Co i -UJ A ion) on I� vt (date(s)) �t �J 1 �G� ( "Special Event"); and WHEREAS, pursuant to of the City's Code and the City's Special Event Regulations, the Applicant must execute an indemnification and hold harmless agreement protecting the City from any and all claims which may arise out of the Special Event. NOW, THEREFORE, in consideration of the matters recited above, the mutual covenants set forth herein, and other good consideration the receipt and sufficiency of which is hereby acknowledged, the Parties hereby agree as follows: 1. The ali'ove recitals are true and correct. 2. Applicant agrees to indemnify, defend and hold the City, its officers, affiliates, employees, successors and assigns, harmless frbm and against any and all such claims, suits, actions, damages, or causes of action arising as a result of the Special Event, or of the condition of the site on which the Special Event is held including any personal injury or loss of life, or damage to or loss of property, and from and against any costs, attorney's fees, expenses or liabilities incurred in and about the defense or settlement of any claims, and the investigation thereof. 3. Permits for Special Events must be on event site at all times. 4. No Street shall be closed without authorization from the City of South Miami Public Works Department and Police Department. I . 5. Traffic shall be maintained in accordance with Florida Department of Transportation (FDOT), Miami -Dade County standards and any additional requirements by the City of South Miami Public Works Department and Police Department. 6. Event areas shall be restored to equal or better condition than they were before the event started. 7. If all restoration work is not performed within 30 days of work completion, the City of South Miami Public Works Department may restore the event area and charge the applicant for the cost of restoration plus a minimum of 15% for administrative fee and any additional incidental fees. 8. Applicant must pay all fees prior to the start of their event(s). 90 Applicants that receive approval for their event more than thirty (30) days in advance shall notify the City of South Miami Special Event/Marketing Coordinator at least forty-eight (48) hours prior to start of their event. 10. Any damage to private property shall be restored to its original condition or better and as accepted by the Owner. IN WITNESS WHEREOF, each of the parties hereto has caused this Agreement to be executed and sealed by its duly authorized signatory(ies) on the date set forth below and notarized. NT APYPLICANT $I3NATURE NOTARY SIGNATURE Subscribed and sworn before me, this /� day ofn1�, a 8 -16 APPLICANT'S TITLE DATE: DATE: �,.•�pprnp�,� Kenia Mendoza =x n= COMMISSION #EE146088 � EXPIRES: NOV. 14 2015 n,°,�,;;� °� WWW.6RONNOTARY.com l 1. 1. CITY OF SOUTH MLAMI POLICE DEPARTMENT r 1 0 MIu a 6130 Sunset Drive, � South Miami F( 33143 (305) 663 -6301 flf4Alverlca &31Y Extra -Duty Police Officers Application w 2001 A police Officer for employment that is indigenous to their law enforcement authority commonly referred to as "Extra- Duty" employment, The following policies and procedures must conform in order to schedule a police officer for employment on a temporary or infrequent basis: ➢ The South Miami Police Department shall be the final authority in determining the minimum number of officers required to police a particular event. If more than three officers are hired, a supervisor must also be hired. The City Manager Office and South Miami Police Department will determine the supervisor to officer ratio for larger events, ➢ The Applicant will be required to compensate the assigned officer for a minimum of three (3) hours even if the event is of a shorter duration. Currently the rate for Extra -Duty Police Officer is $40 per hour & $50 per hour for Supervising Officer, plus a $3.00 charge for radio usage for each officer. ➢ The Applicant must compensate the officer(s) for their services at least one (1) day prior to the start of the scheduled event that the officer(s) will be assigned to. No monetary payment will be accepted. No payment by exchange of goods or services is acceptable. ➢ If, during a scheduled event, the Applicant determines that he /she needs to extend the time an officer(s) works at the assignment, the Applicant shall compensate officer(s) for a full hour worked if the Officer(s) works for more than 20 minutes and /or less 59 minutes beyond the regularly scheduled time of the event. ➢ Applicant must notify of a cancellation request of an Off -Duty Police Officer forty -eight (48) hours prior to the scheduled date of service. Failure to do so will require the Applicant to compensate the assigned officer for a minimum of three (3) hours. APPLICANT INFORMATION Business /Organization Name T Gjj Cva A P�, - Business /Organization Address Applicant Name nth (fl I ami City FL State Zip Code rim elclann i- rb o con Phone Number Fax Number -Mai( INFORMATION 0n -Site Cont ct Person Name of Event __......._.... _.........._..... Cellular Number Type of Event W -: iSA-• u l- - 4 Event Location. Anticipated Attendance u'`a:P pvt' h, f'Q f t" X1=11 i, ate. s'`�t it r .JYCG sJS'Fsrb F v,P Ks+ +My �tu'R Y• + xF.R X14, K ' ae.' d;fa'� ifa ". of °Ouff coal la o:, o- o I acknowlilg d 7 qu�t4" a ept d nciai nsibilities to ay all costs and fees associated with this request form prior to the service date(s): Applicant Stature Date DR OFFICE. USES NL +1�(: ED APPROVED AS PRESENTED F] DENIED APPROVED WITH CONDITION NO. Office: NO. Radio' 10 g NO. Hours ;OMMENT: 'OLICE DEP AGNATURE I1 -16 ./ j Estimated Is DATE / Z - Total Cost N 4r O a) taO w c� .d; cu Wbei KPJ a co J :n k 0 LL M N r O N tom- cu ro co 0 c°'n i-° in 0) a Cl CD aD rn ca c m s ro •� Q� 0 0 0 0 ro a) a� U O N G a) N N U O 0 0 a� 0 L .x O Q o C7 (D Q U C �_ � f0 'O V U 'y a� LO o OQ'tMo to @ L N _ � Z a� 0 0 0 N avnaLC N r a r-i N' M N T-i N rl m a•, I W ro 'u .ro O C (o L C�• C O O In a) L L 0 CL U (a .Q O ro v .0 ro {C U coo 0 N U) N O) C co L U a) a) 0 CL 0 ro r: South Miamt CITY OF SOUTH MIAMI PUBLIC WORKS DEPARTMENT F' ° r' ° a 4795 SW 751h Avenue, Miami, FI 33155 (305) 668 -7205 Fax (305) 6684208 Application to Conduct A Special Event Function on t Public Right -of -Way =oo, NOTE: ALL FIELDS SHALL BE FILLED. No action can be taken on this application until all questions have been answered. As set forth in Ordinance No. 21 -09 -2013; temporary full roadway and sidewalk closure (NO SINGLE LANE ROADWAY CLOSURE PERMITTED) for special events, eight (8) hours max. Schedule of fees is attached. Use blank paper if you need additional writing space. PLEASE PRINT clearly, except for signature. I,,� iN iin Con( mun 1kt VIc P Ao L Business /Organization Name Authorized Representative Name Business /Organization Address City State Zip Code Phone Number . Fax Number E -Mail Event Information: 1^ (j Event Name t,�K4n �. o i � 4l.,,t ( �Ct � r ' � t►` Project Location 90-r" V� oeJYkQ2n (S AkQf-u-ecAiJ (o i Event Date(s) Q a�J ��. Event Day(s) Type of Event ...Pe Event Start Time 0 . aO am pm) Event End -Time .. (am ( pm Anticipated Attendance Event.Setup Time (am pm) Breakdown Time (am /o Total Duration (include setup) 1 HEREBY REQUEST A PERMIT POR THE FOLLOWING: Anticipated effects on vehicular and pedestrian traffic during Project Maintenance of traffic provisions are specific (include sketch if necessary): The fo bowing documents have been submitted with this permit application: Site plan / sketch of event. Clearly define boundaries and linear foot of road closures. F] - Maintenance of Traffic (MOT) for vehicular and pedestrian traffic during event. `In signing this application, t understand that separate City any responsible for ensuring that the project is completed in accorc well as acknowledge that any right -of -way closures will require PRI NOTARY SIGNATURE FOR .QFFICE IJS y permits may be required for this project. Furthermore, t am aware that i am the plans and eci ations as stipulated in the permit approval conditions. As ie off-d office , lic works employee and barricades." S `� 2.o 1 .7, W„T,,SJ ATURE DATE MISSION # EE 1460$8 RES: NOV. 14, 2015 Permit No: Approved/ 13y Date o Permit Fee Comments Disapproved U 12 -16 Permit Fee Applicant: Larkin Hospital Ordinance Item Permit #: Date: 5/16/2012 Total Measurement Fee Actual Unit Permit Fee *For special event 8 hr. period max., incl. set up time. Excludes city events and events funded by the city. Permit Fee Total: $250.00 PERMIT FEES Minimum permit fee $150 $0.00 Permit extension fee, for 60 day period $150 $0.00 TEMPORARY FULL ROAD AND SIDEWALK CLOSURE 0 -50 LF 51 -300 LF $1,500 $26500 $0.00 $0.00 No single lane roadway closure permitted. * Every additional 50 LF or fraction: $1,000 $0.00 Excludes city events and events funded by the city. Maximum Permit fee $10,000 $0.00 Per linear. Ft.of road, rounded to the next higher whole number in ft.,per day $0.25 1000 $250.00 TEMPORARY SIDEWALK CLOSURE Each 25 SF or fraction $75 $0.00 Permit requires French barricades along curb or EOP.* Maximum permit fee $10,000 $0.00 TEMPORARY STAGING AREA, CRANE, TRAILER, TRUCK ON THE RIGHT• Flat Fee per day for first 5 days $200 $0.00 OF -WAY Every five days or fraction thereof after $300 $0.00 *For special event 8 hr. period max., incl. set up time. Excludes city events and events funded by the city. Permit Fee Total: $250.00 4 7 Ij d�Y t q i CITY OF SOUTH MIAMI PARKING DIVISION 6130 Sunset Drive, South Miami, FI 33143 (305) 668 -2512 Fax (305) 663 -6346 Parking Stalls /Meters Rentals Application South Miami F i o r l d a popw AII- AMolIC44 City 2001 Pursuant to Section 15 C -1 (a) (2) (b) of the Code of Ordinance, "Rental Fees for Public On/Street curbside spaces (Parking space) are $25.00 per space per day, seven days per week based on twenty -four (24) hour use ". Wa inn Comy uno, c { SPA- �oe000y u wo Business /Organization Name `� Applicant N %-10E>I ao coo `ij A, S (Yi x'1'1 / Business /Organization Address City -3 GCOG35) O&A 45 1,q CIA Phone Number Fax Number Name of Event: Purpose for utili State Zip Code ioe6n ho NO E -Mail �Q �+rn�CrYIiYonili HPirk�l� H 11I ,Xype of Event: kCA 14h 1:1d zing parking meters:. CQ z: A . Number of On /Street ? Number of Day's j Start I a.m End /I a.m. curbside spaces requested: 3 curbside spaces desired:. 1 Time: c> (7 p.m. Time: (If necessary, please attach additional sheets) I hereby certify the above info ion is true, correct and complete as of the date of this submittal. it is understood that this applicant will be revie d and ay be adjustedically by City Staff; if any information should change that I shall amend or supplement thi icat'on within five b sinp* days of the change. % Applicant's Signalire F.O,R ,OFFICE; USES:.ONLY:_ 0 DENIED NO. Meter Days: Mein Permit No: M APPROVED AS PRESENTED :X: NO. Meter: ['] APPROVED WITH CONDITION Daily Fee :'11,1 S10 (0 0 r, � 14 -16 Estimated Total Cost In M1 a d oc)t `/ no ,Z 10 (01 p I CAVI f V v r 7 0O�,'1o�G� 2 'lo�� ?(33? )13 V i Submitted To: Name of Event: Event Date (s): CITY OF SOUTH MIAMI Public Works Department Event Cost Estimate Maria Stout -Tate Larkin community Hospital Health Fair June 23, 2012 Personnel: Cost• ~ Saturday, June 23, 2012 10:00 AM to 5 :00 PM Two employee's $560.00 FICA $ 42.84 $602.84 Materials: Cost: a Equipments: Cost: Barricades $ Date Prepared: Grand Total: $602.84 Approved by: Public Works May 21, 2012 City of South Miami 6130 Sunset Drive South Miami, FL 33143 Re: Larkin Community Hospital, Inc. To Whom It May Concern: Brown fir iirown of Florida, Ina Mimrd division 14M NW 79th Ccur, Suite 200 Miami Lakes, FL. 33016 -W (306) 364-7M Fax (305) 714.4401 The General Liability policy for Larkin Community Hospital, Inc. is scheduled to renew on 06/21/2012. Upon renewal of the policy our office will issue a Certificate of Insurance naming the City of South Miami as additional insured for the Health Fair on 06/23/20124 Please feel free to contact out office with any questions. Sincerely,. Brown d Brown of Florida, Inc Miami Division Norman Morris Senior Vice President ACOR,O'" CERTIFICATE OF LIABILITY INSURANCE LARKI -5 OP ID: rDATE(MM /DD/YYYY) 05/15/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 305 - 364 4800 BROWN & BROWN OF FLORIDA INC 14900 NW 79th Court Suite #200 305- 714 4401 Miami Lakes, FL 33016 -5869 Norman Morris INSURERA:Darwin Select Insurance Co 24319 INSURED Larkin Community Hospital, Inc INSURERB:RLI Insurance Company 13056 Attn: Ms. Berges INSURERc:Retail First Insurance Co. 10700 7031 SW 62 Avenue South Miami, FL 33143 INSURER D: INSURER E INSURER F L`lIVFRA(.7FR r`FRTIFICATF fdI1MRFR• RFVI.glnM KII IMRFRI THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPEOFINSURANCE ADDLSUB POLICY UMBER POLICY EFF POLICY EXP LIMITS A GENERAL LIABILITY 'X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR X 03067568 06/21/11 06/21/12 EACH OCCURRENCE $ 1,000900 PREMISES RFNIEu occurrence) $ 100100 MED EXP (Any one person) $ 5300 PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ 3,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC PRODUCTS - COMP /OP AGG $ EBL $ 11000,00 B AUTOMOBILE LIABILITY X ANYAUTO ALLOWNED SCHEDULED X HIRED AUTOS X N ON AUTOS CAP9502321 04/15/12 04/15113 I COMBINED SINGLE LIMIT Ea accident $ 3,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident PIP $ 10100 A X UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE 03067569 06/21/11 06/21/12 EACH OCCURRENCE $ 500900 AGGREGATE $ 500500 DED I X RETENTION 26v000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y� OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 52039708 02/15/12 02/15/13 X WOC STATU- TOR`�LIMITS O ER R E.L. EACH ACCIDENT $ 500100 E.L. DISEASE - FA EMPLOYE $ 500000 E.L. DISEASE - POLICY LIMIT $ 500100 A Professional Liab. 03067568 06/21/11 06121/12 EachClaim 11000100 Aggregate 3,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: Health Fair 06/21/12. The City of South Miami is listed as additional insured in respect to General Liability as required by written contract. MIAMICI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of South Miami ACCORDANCE WITH THE POLICY PROVISIONS. 6130 Sunset Drive South Miami; FL 33143 AUTHORIZED REPRESENTATIVE ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD CASH RECEIPT City of South Miami FUND RECEIVED OF DESCRIPTION PLEASE MAKE ALL CHECKS PAYABLE TO: "CITY OF SOUTH MIAMI" VALID ONLY WHENBEARING OFFICIAL REGISTER VALIDATION CASH CHECK • DATE: 15/,ta4) I 0 ACCOUNT NO AMOUNT $ o�? / E t w O W r O Z Q A r O X W Eo Z Q N Z H Z O CO) H W Z U O A U H Y CO) a m w x