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Res No 211-11-13525RESOLUTION NO. 211-11-13525 A Resolution, authorizing the City Manager to permit Earth Learning, Inc., a non - profit corporation, to operate a Farmers Market on the parking lot of City Hall on Saturday, November 26, 2011, Saturday, December 3, 2011, Saturday, December 10, 2011 and Saturday, December 17, 2011. WHEREAS, Resolution number 27- 03- 11576, Section 2, requires that all organizations sponsoring a Special Event must receive approval by resolution from South Miami City Commission; and, WHEREAS, the City Commission desires to continue the operations of the Farmers Market until such time as the Commission has an opportunity to address an ordinance approving a Farmers Market Franchise with Earth Learning, Inc. WHEREAS, a Fanners Market Franchise Ordinance cannot be enacted until the week of December 19th, 2011. NOW, THEREFORE, BE IT RESOLVED BY THE MAYOR AND CITY COMMISSION OF THE CITY OF SOUTH MIAMI, FLORIDA: Section 1. The City Manager is hereby authorized to permit Earth Leaming, Inc. to operate a Farmers Market on the parking lot of City Hall on Saturday, November 26, 2011, Saturday, December 3, 2011, Saturday, December 10, 2011 and Saturday, December 17, 2011 and the fees are waived for this time period. Section 2. This resolution shall take effect immediately upon adoption. PASSED AND ADOPTED this 22 "d day of November, 2011. ATTEST: Y CLERK MAYOR PI�RtSVED A RM, COMMIS SION VOTE: 3 -0 LEGALI AN Mayor Stoddard: Yea KREADA THERE Vice Mayor Newman: absent Commissioner Beasley: Yea Commissioner Palmer: absent NE / Commissioner Harris: Yea Sup t� of agent 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 121} daVS prior to the effective date of the event with all required documents. TYPE OF EVENT: D Filming [:] Charity ❑ Festivals ❑ Celebration o Promotion Other: Farmers' Market NAME OF EVENT: South Miami Farmers' Market LOCATION OF EVENT: City HaII Parking Lot (Please note: write complete mailing address, as well as name of any buildings and /or parks Is this an annual event? x] No 0 Yes if yes, this is the` annual event, previous date EVENT DATE(S): Every Saturday EVENT DAY(S): Every Saturday ACTUAL EVENT HOURS: 9 am a.m. /p.m. UNTIL: 2 pm a.m. /p.m. (Please note: event may not begin earlier fhen 8a-m- orend later then 11 p.m. in residential areas, or midnight;(1 commercial areas) ASSEMBLY DATE(S): Every Saturday SETUP /DOWN TIMES: 7 am _a.m. /p.m. 3 Pm a.m. /p.m. ANTICIPATED ATTENDANCE: 300 all day TOTAL EVENT DURATION: 5 hrs mins Name: Mario Yanez Name: Title: Director Title: Cell /Phone: 305 323 -8858 _ Email: mario @earth- learning.org Cell /Phone: FOM Farmers' Market, a place where community happens and people connect over local and sustainably -grown foods, music, artisanal crafts, workshops, healthy cooking demos, children's activities and r ar& - 1 -16 A P1 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: 5825 SW 68 Street, Suite A South Miami. FL 33143 OFFICE TELEPHONE: 786 - 233 -2784 FAX: 305 595 -7566 _ PRESIDENT: Mario Yanez SECRETARY: Dion Taylor ADDRESS: 5825 SW 68 Suite Al PRES. PHONE: 305 323 -8858 EMAIL: mario(a7 earth- learninq.org SEC. PHONE: EMAIL Dtaylor07 gmail.com If the organization is a tenant and /or renter of the event location, please have the property owner complete the following: Applicant/Organization owns the event location [� 1 give permission for the Applicant/Organization to use my property. Comments: Property Owner's Name: Property Owner's Address: 2 -16 !g'.]M Property Owner's Signature: (rotary Si€grrature. EVENT POLICE DEPARTMENT Date: YES NO 1 0 [Will your event obstruct the normal flow of traffic? 2. Ej L Do you expect the total attendance for your event to be over 150 people at any one given time? 3. V2,`IWHI you be requesting the use of Extra -Duty Police Officers? If yes, how many _ (Please note: if you answered N0, to this question off -duty officers can still be assigned to your event at a cost to you if deemed necessary) If NO, please describe why the event will not have a significant impact on the surrounding public streets and /or property area. pg.19 IS Special Event Fee PUBLIC WORKS YES NO 4. [(Will your event interfere with any public right -of -way, such as roads, sidewalks, alley, etc.? 5, [ Will your event require any full and /or partial road closures? If yes, please complete the Right -of -Way Application. (Please note: any right-of-way closures will require at least one off -duty officer and public works employee.) g, [] Will your event require the use of barricades? If yes: how many what type � (G k h� -Ir aA4 (Please note: all pubic right -of -way closures must have approved barricades) 7, n axWould you like the City to provide you with barricades for you event, at a cost? If yes: how many g. ❑ ©/ Will you be applying for a Pole Banner? Please describe your plans for the cleanup and removal of recyclable goods, waste and garbage during and after your event. 3 -16 rht -Of -Way Applicant p9.12 /Pole Banner pp scan pg. See Special Event Fee Schedule for cost detail PLANNING AND ZONING YES O g, ( C] Are you confident that your event is in the City of South Miami limits? bilit of the applicant to ascertain the (Please note: that tt is the sole response y location is within the city's limit. You may call the Planning & Zoning department at (305) 6636326 if you have any question(s).) [� Will you be hanging any banners over public streets? If yes, please complete the Hanging Banner Application. ("'I aA (Please note: that all requests for banner over public streets must be reviewed and approved by the city Commission, which meets only twice a month.) 11 FFJ� F__] Have you notified the event location neighbors about your event? i- ra�ninrr Banner over Street Applicant pg.14 /See Special Event Fee Schedule for PARKING DIVISION YES NO 12 Will you be renting any City parking meters? If yes, how many (Please note: that if you are closing or interfering with any right -o€ -way that includes parking meters you are required to pay the meter fee as well.) 13. Do you have enough on -site parking to accommodate your event? 14 . [Will your event involve the use of a shuttle and /or alternate parking sites? AeterRental Applicant p9.7sisee apeaaj Gv61<, CODE ENFORCEMENT YES NO 15. [Ej� ❑ Will you behaving any music and /or loud sounds during your event? 16. C] [Will your event be starting before 8 a.m.? 17 ❑ Will your event end after 11 p.m. on a weekday and /or 12 a.m. weekend? PARKS AND RECREATION YES NO 18. Will this event take place in any of the South Miami City parks? (Please note: A rental fee will be applicable if a City Park is being utilized. 4 -16 i Reservations are made through the Parks & Recreation Department (305) 663 -6399 or(305)668- 7232). 19 Will this event require the use of any Parks equipment or staff? Site �an�sk�etch A map of the event site is required and should indicate event layout with proposed attractions, recommended sheet closures, parade or run/walk routes, etc. Please draw you map on the space provided below, or attach your map to the application upon submittal. The following must be identified and labeled: 1. Event Site (label streets, building, etc.) 3. canopies, tents, stages s. Fencing /Barricades x -X -X 7. First aid facilities z 2. Routes (races, parades, etc.) 44 4. Restroom facilities R 6, off duty police officers P 8. Parking Area PA 5 -16 See attached exhibit 9b 2— OTIFICATI ®N / PETITION Event Name: >O� Event Date: S�� F t� S 6 -16 We, the undersigned businesses andlor [Psidents, 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. i p P l Approved ❑ Disapproved ❑ Approved ❑ Disapproved ❑ Approved ❑ Disapproved ❑ Approved ❑ Disapproved ❑ Approved ❑ Disapproved ❑ Approved ❑ Disapproved ❑ Approved ❑ Disapproved ❑ Approved ❑ Disapproved ❑ Approved ❑ Disapproved ❑ Approved ❑ Disapproved ❑ General requirements _ ✓ When marking any public street curb 7 -I6 All marking agents must be removed immediately after the completion of the event. rental fee established by the Public Works Department. • Barricades shall require an additional • No pegs, stakes, or anchoring devices shall be driven into the concrete, asphalt, or City hardened right -of- way. • Map of route or site plan of the scheduled event including all stations and descriptions of activif - ✓ Any temporary cover for stations such as a canopy shall be flame retardant and applicant shall provide proof of such certificate. • Review of a licanYs a er work to note location an food sales volume of noise/music and duration. ✓ 72 hour notice given to all merchants whose street would be closed.�� Please initial Sectio n II....__� -- -- ✓ In the event of a parade, a permit from the South Miami Police Department must be obtained. ✓ (f Police service for trafFc and/or crowd control is required, arrangements will be made through the City off' South Miami Police Department for off -duty Police officers. The Police Department will determine the number of officers required. (Please be aware that costs might change on a yearly basis). ✓ Code Enforcement De artment.will check on each event to make sure that all codes and re ulafions are 9 to the event! ✓ Barricades: The average hourly rate for 125 Barricades for one (1) day usage is approximately $80.0 tl. Please initial Section III I '➢S ecific Re uirements: All or anizations sponsoring ea _r„ n`i hvre resolution from the South —MI—am-1 City or by the City. ✓ A majority vote of approval (one -mon #h in advance) by the City Commission will be required for large V events. Y must accompany application, ✓ Deposit of Six Hundred Dollars ($600.00) to defray cost of litter clean -up, P Y PP plus a permit fee of $60.00. If clean -up is not required, deposit may be refunded. The litter deposit may differ depending upon the event. ($100.00 will be retained by the City as an Administrative processing fee deducted from the $600.00 deposit). 1,, ham G ri,ia to cost of living increases). ➢ (Please ne aware a ai a o� �••�•• ••• • - - -- — ➢ For Grant Recipients: Pa ment of these char es could be deducted from the dest na e rant amounk approved by the City. ✓ Public Works — The average hourly rates are approximate $40.00 per non - supervising employee, per hour, and $45.00 for supervising employee; per hour. Please initial INDEMNIFI .AGREEMENT THIS AOREEMENT ( "Agreement ") is entered into by and between ( "Applicant'), and tite City of South Miami ( "City ") on the data on which the last of the Parties executes thi, greement. rFczTAz,s me WHEREAS, the Applicant has submitted at Special Event Permit ff Ap(plica�}tion t9 the City for (event title) at �( �`a'�t/ 1b)4, ` LoNlp 1 e (location) on (date(s)) Q` �U C'� ( "Special Event"); and WHEREAS, pursuant to of the City's Code and the City's Special Event Regulatio s, the Applicant must execute an indemnification and hold harmless agreement protecting the City from any and all claimms 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: I . The above recitals are true and correct. 2. Applicant agrees to indemnify, defend and hold the City, its officers, affiliates, employees, successors and assigns, harmless from and against any and all such claims, suits, actions, damages, or causes of action arising as a result of the Spacial 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 oil 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. 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. G. 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). 9. 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 ESS WHEREOF, each of the parties hereto has caused this Agreement to be executed and sealed by its duly WITN authorized signatory(ies) on the date set ford' below. TA r - PRINT NAME AP LICAI APPLICANT'S TITLE EXPIRES October 05, 2015 Ike a rtmeaLAl aro2vral sheet REVIEW BY CITY OF SOUTH MIAMI DEPARTMENTS: Each department will provide estimate of number of personnel required from their department to provide appropriate services for this event, along with an estimate of cost to applicant. ME Signature: Comments/Conditions: Comments/Conditions: Sk]nutxa:_______- : Comments/Conditions Rnm{W�xN Event Date: ----� Total No�NDays /'".~ [�� Dep. ���mu�dCo� Remoioio0Ti|[vant____'__~APp,ovoouep- o'p","" �__-_-____� Commeoh,/Po/mitC^ndiiiuAo: WNAGM OF510E USE ONLY: Cornments/Permit Conditions: � Authorization Signature: l0-i6 South 'tgt'est Parking 1- Parking East f— Library North Earth Learning, Inc. 1858 1112212011 60.00 City of South Miami Permits & Fees Citibank Checking PATE (MMIDDIYYYY) A � CERTIFICAT OF LIABILITY INSU ICE 11121(2011 PRODUCER Fax& 305- 444 -8811 Ph-4 305 - 992 -1907 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Global Insurance Solutions ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1421 SW 8th Street, ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, Suite #3 Miami, FL 33135 INSURERS AFFORDING COVERAGE NAIL # INSURED Earth Learning, Inc. INSURERA: Catlin S eoialt Insurance Compan 8201 SW 99th Court NSURER e: Miami, FL 33173 COVERAGES THE ANY MAY POLICIES. INSR RACH POLICIES REQUIREMENT, PERTAIN, OF INSURANCE LISTED BELOW TERM OR CONDITION THE INSURANCE AFFORDED AGGREGATE LIMITS SHOWN MAY HAVE BEEN ISSUED TO THE INSURED OF ANY CONTRACT OR OTHER BYTHE POLICIES DESCRIBED HEREIN HAVE BEEN REDUCED BY PAID PpOUCY NAMED ABOVE DOCUMENT WITH IS SUBJECT CLAIMS. EF OGTIVE 11/15/2011 FOR THE POLICY RESPECT TO WHICH TO ALL THE TERMS, POLICY!'.Xplri -" 11/16/2012 PERIOD INDICATED. NOTWITHSTANDING THIS CERTIFICATE MAY BE ISSUED OR EXCLUSIONS AND CONDITIONS OF SUCH LIMITS OCCURRENCE $ 1 000 000 L TIAPPL�IES YGEWL 4200502743 pA A OREN ED eB MISES Eaocmrence $ 100,000 $5,000 PERSONAL&AOV INJURY $1,000,000 GENERALAGGREGATE $2,000,000 PRODUCTS - COMP /OP AGG $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea acident) $ ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS HIREDAUTOS BODILY INJURY (Por accident) $ NOWOWNED AUTOS PROPERTY DAMAGE (Per accident) $ AUTO ONLY- EAACCIDEN7 $ EA ACC OTHER THAN AUTO ONLY: AGG $ GARAGELIABILITY ANY AUTO $ EXCESS I UMBRELLA LIABILITY OCCUR EI CLAIMS MADE EACHOCCURRENCE $ AGGREGATE S $ 5 DEDUCTIBLE s RETENTION $ WC STATU- OTIi- WORKERS COMPENSATION E.L. EACH S AND EMPLOYERS' LIABILITY YiN ANY PROPRIETORIPARTNEWEXECUTI VE OFFICERNE EXCLUDED? (Ma ry n NH) VYe$, describe PROVunder SPECIAL ISIONS below _ACCIDENT E DISEASE- CA EMPLOYE S E.1- DISEASE; POLICY LIMIT S_ - OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 1 EXCLUSIONSADDED BY ENDORSEMENT I SPECIAL PROVISIONS Additional Insured Endorsement CIS 2010- City of South Miami k(I 11-0.:A I c nvt -VCrt 1x11 w- - .......- I- ..._.._.. __ - ___ y of South Miami SHOULDANYOFTHE ABOVEDESCRISED POLICIES Be CANCELLED BEFORETHE EXPIRATION 30 Sunset Drive DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRn -TEN ,uth Miami, FL 33143 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ACORD 25 (2009/01) ©1988 -2009 ACORD CORPORATION. All rights reserved - The ACORD name and logo are registered marks of ACORD IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2009M) N001075163 —*-RENEWAL L CERTIFIC A` E * *x Renewal or Number United States Liability Insurance Company POLICY DECLARATIONS 1190 Devosa. Park Drive, Way;:xe, Penaxsy%vaWa 19087 No. ND010 75163A A Member Company o`r United States Liability Insurance Group NAMED INSURED AND ADDRESS: Earth Learning, Inc. 8201 SW99'th,Court P,iliami, FL 33178 POLICY PERIOD: (MO, DAY YR.) From: 11/15/2011 To: 11115/2012 17-01 MAIN STANDARD SHOWN MOVE MAILING ADDRESS SHOWN ABOVE RI iemiGec nG£3r;RIPTiON: Non - Profit Directors and Officers Agent: CAPSTONE UNDERWRITERS, INC. (1054) "' 4144 North Central Expressway, suite 1250 Daoba in uranc 289 - aroker. Global insurance Solutions ey' 1421 Southwest 8th Street, Suite 3 Authorized Represe ti e Miami, FL 33135 THESE DECLARATIONS TOGETHER WITH THE COMMON POLICYCONDIT10N5, COVERAGE PART DECLARATIONS, COVERAGE PART COVERAGE UPC(08 -07) FORDI(S) AND FORMSAND ENDORSET415NTS, IF ANY, ISSUED TO FORIA APART THEREOF, COrAPLETE THE ABOVE NUMBERED POLICY. EXTENSION OF DECLARATIONS Policy No ND01076163A Effective Date: 1119512011 12:01 AM STANDARD TIME FOPJVIS AND ENDORSEMENT,$ � The following forms apply to the Professional Liability coverage part Endt# Revised Description of Endorsements DO -100 04/07 Coverage Pact A. Non Profit Directors and Officers Liability * DO-FL 04107 Florida State Amendatory Endorsement DO Jacket 09/10 Non Profit Professional Liability Policy USL -DO J 04107 Professional Liability Policy Common Policy Conditions Endorsements marked wilh an asterisk ( ") have been added to this policy or have anew edition date and are attached with this certificate. EOD (005) All other terms and conditions remain unchanged. Page 1 PROFESSIONAL LIABILITY COVERAGE PART DECLARATIONS PLEASE READ YOUR POLICY CAREFULLY. THIS IS A CLAIMS MADE POLICY COVERAGE FORM AND UNLESS OTHERWISE PROVIDED HEREIN, THE COVERAGE OF THIS FORM IS LIMITED TO LIABILITY FOR CLAIMS FIRST MADE DURING THE POLICY PERIOD, OR THE EXTENSION PERIOD, IF APPLICABLE: DEFENSE COSTS SHALL BE APPLIED AGAINST THE RETENTION. No. ND01076163A ITEM I. PARENT ORGANIZATION AND PRINCIPAL ADDRESS Earth Learning, Inc. 8201 SW 99th Court Miami, FL 33173 Effective Date: IIMB12011 ITEM II. POLICY PERIOD: (MO. DAY YR.) From: 11/1512011 To: 11/1512012 Coverage Part A: Non Profit Directors and Queers Liability ITEM III. LIMITS OF LIABILITY a. Non Profit Directors & Officers $1,000,000 EACH CLAIM b. Non Profit Directors & Officers $1,000,000 IN THE AGGREGATE ITEM IV. RETENTION: $0 EACH CLAIM ITEM V. PREMIUM: $$00 Coverage Part B: Employment Practices Liability ITEM 141. LIMITS OF LIABILITY a, Employment Practices NOT COVERED b. Employment Practices ITEM IV. RETENTION: NOT COVERED ITEM V. PREMIUM: NOT COVERED 12:01 AM STANDARD TIME ITEM Vf. Coverage Form($) /Part(s) and Endorsement(s) made a part of this policy at time of issue: See Endorsement FOD (01195) Page 1 Of 7 Capstone Underwriters, LLC 414, Dslla=, IX - vjsts (,,300; t82-L564 , jax: (214, 520 3615 RAUL CAF-14:34A T',.q. A,',i -42i SX KH 97., SUITE 3 lli-Aml --L '3135 i<-:_v '-15-11 to Sl.?fdn-d Tirrr M7 AINT FT., Prc✓ mo ISO. 4201)9-274- CATLlY S?E--:i~LTY I?-S. CO, Surpims Lines Insurers' Pogc:Y Rates aud Forms are not Approved by arky Norid"t Re Agency croonc,l 5 Aslv-,rcLcilw 1'.IjurY ou, :act o=uxrence - -nit L.- - -. Pr_-Ae,A Dcdt.0ti,olo: (N; t 1 ?cr Occurrolicc is RaI.lmj $ I-. 13. . . FP.-,,TT -VF.7,F.T7%P.TP S40,000 SAT,=S - PREATSES ?A-P. $9.0 AHr PROD' TS P ODE BUILDIIT� OR PPEK:SFS 0R OEFICE 11C2. 2c PER S>00 OF AREA (x 'coftinucd or Pzllc 2 .,'A--PL115 --'n;m Tax $1 C. ^l T'`'` -S $5 o 2F., TOL:AL 2It DTTT-mS: -FR PROVURD VA" NOT 1,1--T -H� -FWAS OR CCNT--TTCP T---F, •TIOY. THE POLICY CC:VER,,"tGE, TERMS APE C0llDI---0NS WILL ?REWIL , THIS KNDER W,:,TINI-'jUS UNTIL A IU -SSULL, lHAWK YO_ FC-:k `_:OUR FRM�LTM )rjDMNCE C01dPANTES MST ZM7D C7,2STOM UtWrMl�XTSaS , MMC D-.te Ncven�se-- 10, 201- (OMY417DC0677-020819flilliSIO62) C,.-my *,,c;n7. ;:t.: ,TAT - NP. -VITTKz- ON r,Yn 4i(705:111 -rcPaded ,;il Orly applvr rK,"' -t : TSC cadorse"neats, -,rd . *,Tpany soaC�I-Zlc -tom .S Co o-.)tlined wit-li"a tf �U.Ote. 1-0; 21�1-a - L14:1; lq"*, I'lal. P-,.efldjn 16 & ivldit.-'onrO Tn.;Ijred 'it of Car prom U.M:3 arc Yu. -_y 3��=qcd; HDn-P,7nimc, P::op1-Jjrr, - -o311.aticno ago ccr-S-4d--Iqd -nSuxed's reque--c and ,il-- be sVort-race o-- r4bp; --rer.1-4um _us_ X:ee,-jvad olLhin -j :Asy= xnlos8 y L. U- r)JC7L be Made L:L V'ritinq• We "I'll requ re t1e fu-Lo,,-1t,q Lo hie Y,--a N i�sques- -Ra" N71 T f� ny 7,pp At��l cl- n,-) , ��l C, t cl g2 9-,-.rca/Ditcd SU'OPlcMc'1ta- A�,Dc-lcd XPUA L, A v,, (:npy C!X:— ,nt. kun� (0%4n1171)CO677X-a2OaODfillilgIO5Z ORT.7;TPA-, C'MzV ,�-\�ttaChod List of Other. Interests Reference number: 4200501176 Date: 11-15-11 Acklitional insured CITY OF SOUTH MIAMI 6130 SUNSET DRIVE SOUTH MIAMI FL 33143 Page I Receives Other Interest Cooy ORIGINA.L Copy (OMNI 7 0CPRTJNT.020808111i 1181062)