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3To: Via: Via: From: Date: SUbject: CITY OF SOUTH MIAMI OFFICE OF THE CITY MANAGER INTER-OFFICE MEMORANDUM The Honorable Mayor & Members of the City Commission South Miami bOd imp 2001 Hector Mirabile, PhD, City Manager 17/ '/...~ fl ~ . _ d. / '7 <Ajj~1Jtl{A:(p,-r dlJiptLA:rL- Carmen Baker, Chief Coordinating Officer/Code Enforcement r5i;;;<itor . Maria E. Stout-Tate, Special Events Coordinator ~, ? May 16,2012 Agenda Item No.:~ 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 70 th 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 requestin~ permission to hold its event, a Health Fair, on Saturday, June 23, 2012, on SW 70 Street and SW 61 Court. Expense: Account: Attachments: 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). $2,812.84 Not Applicable Proposed Resolution #OTE~ GV£7I.1T n/nt'J FOR. ;JUno(' ,23/Z0 / L jj Fi2WT) It): go am -4: 30?.f'n . 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 RESOLUTION NO. __________ __ 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 70 TH 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 70th 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), (l055 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 23 rd , 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 __ day of ______ , 2012. ATTEST: APPROVED: CITY CLERK READ AND APPROVED AS TO FORM, LANGUAGE, LEGALITY AND EXECUTION THEREOF CITY ATTORNEY Page 1 of 1 MAYOR COMMISSION VOTE: Mayor Stoddard: Vice Mayor Liebman: Commissioner Newman: Commissioner Harris: Commissioner Welsh: ----------------------~--------------------"-JMMAR Y 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: D Filming D Charity D Festivals D Celebration D Promotion Other: Heo\-\h Fdl(2.... NAME OF EVENT: LafL\(J(\ (OnNiUl \:hj Ho;pMoL ~a \-\\r} Fa \(2 LOCATION OF EVENT: "10'"" S-tl2l22-t be-luJmn CD;;ld ~ c::nj COIG.-t AJ12r\£ (303\ 9J)(O;>rd A)Qf}® (Please note: write complete mailing address, as well as name of any buildings and/or parks if applicable) Is this an annual event?~NO DYes if yes, this is the __ annual event, previous date ___ _ EVENTDATE(S): (£lIdO \G EVENTDAY(S): S:xtvQd0tj ACTUAL EVENT HOURS: 10: eo ~JP.m. UNTIL: --4.: -3:J . , a.m.@ (Please note: event may not begin earlier then 8 a.m. or end later then 11 p.rn. in residential areas, or midnight in commercial areas) ASSEMBLYDATE(S): <..o\d3\\a SETUP/DOWNTIMES: ~p.m.Ra.m@ ANTICIPATED ATTENDANCE: B:D TOTAL EVENT DURATION: \.5 C6!§) mins Name: :J(:2\rD()~ N.Jno·· Name: Title: !lb(2..\Ce-¥;0Cj Cro(2Ck'Oh::i:ritle: --+---~~..L.l.UL._----f­ Cell/P hone: (~J 0l8L\ -=l sClS Cell/Phone:_-+-f.2Arn:-f:ft!+::(i.Rf~:ru+-HttIf:!~!-I- Email:J nurD@ lcR t..{l b:1erlol·~ail: _______ _ APPliCANT/SPONSOR INFOKMATION 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 perl')1itting process. A professional event organizer, or other representative, may apply for the Special Event permit on behalf of the organization/business. NAME OF ORGANIZATION: La(2 t-In Canrrun\'\1 \-b~ p\.-\o l ADDRESS OF ORGANIZATION: =ro3\ 9JJ Ca;(xJ ~ (S::D-\h (Yl\Om\ \ R :3~ \43 OFFICE TELEPHONE: ~ ') ~-.::}5D FAX: (;:oS) df?A -=tS(4 PRESIDEN<l~ ~S'O -bl2@2.o€ciC8J;ECRETARY: IDQ.\OI\f G:PdoJa ADDRESS: SqqLO W ~h S\i2e:2A Sl.Bh (YJIO()\I, Fe 631-43 PRES. PHONE: ewes) d?J4 --=t=iOJ SEC. PHONE: (~);€A --=t-=tO\ EMAIL: N \ A ----~~~~---------------- EMAIL: acddoJa@ \o(2\6n bjpl-bl . . '. . (XJI( If the organization is a tenant and/or renter of the event location, please have the property owner complete the following: rnAPPlicant/Organization owns the event location D I give permission for the Applicant/Organization to use my property. Comments: --------------------------------~~------------------------ Property Owner's Name: ________ ---, ____ Phone: ___________ _ Property Owner's Address: Property Owner's Signature: _____________________ _ Date: ---------------~ Notary Signature: 2-16 ~OTIFICATION I PETITION Event Date:b ,I /2 3 f GO I Z 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. Disapproved 0 ~LPlO~ 1>0"$ v LDlou Dial Disapproved 0 J-lfHlfn,,," . 0 Disapproved o Disapproved 0 nnrrH,<:>n 0 Disapproved D nnrr"",,,, 0 Disapproved Approved 0 Disapproved 0 proved 0 Disapproved 0 6-16 1ND~ICATION AGR,.illMENT THIS AGREEMENT ("Agreement") is entered into by and between lat2 ~n CmYnU()' ("Applicant"), and the City of South Miami ("City") on the date on which the last of the Parties executes t RECITALS WHEREAS, the Applicant has submitted a Special Event Permit Application to the City for (event ~le) LOQt ,,, (mrrnun~ Hc1Prto \ t-rul-l'l ID\Q=totl' S+· C-rf2-o1\ CiJ I-lad h~Jlocation) on (date(s)) (0 id2> 116 . ("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 above recitals are true and correct. 2. Applicant'agrees to indemnity, 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 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. 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). 9. Applicants that receive approval for their event more than thirty (30) days in advance shall notity the City of South Miami Special EventlMarketing 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. NOTARY SIGNATURE Subscribed and sworn before me, this / qJt, day of Bpril "UJ I Z--,a Notary Public in and fo County, State":..F.:..cf f---I----i----- Signatu 8-16 C£Q APPLICANT'S TITLE DATE: DATE: ,""'It K' M d $~~Y.fft~'~ ema en oza g~·£·~gOMMISSION#EE146088 ;~;;,. ..·;?,.EEXPIRES: NOV. 14,2015 0.;;('-oitf\.('i ...... ' """',,,\,,' WWW.AARONNOTARY.com CITY OF SOUTH MIAMI POLICE DEPARTMENT 6130 Sunset Drive, South Miami, Fl33143 (305) 663-6301 Extra-Duty Police Officers' Application South Ml:dOl.t FlorIda bftx:jf fIlIi! 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 c;fetermine 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 ~~~~0~ tkipTbl"'" x '-:-;-PP-:-:i<,--'~-=-::-:-":-:--' :_~~_~-:-~+" _""?_H~_",_-=--,~~Ii,c'",-rD-"","" =-:'_""'_~""_"~!'"_'?"*_'W~_"4 __ ""'_'!'._",",_ .•. 4_,¥012_ .... ~3\ SLU CDdY'ldAQ. m\) n1lam',_--=F,--:-L __ Business/Organization Address City State Zip Code (3)3)dB4 ---:tSX) Phone Number iir1}fD@\O(2tJ(lrcfp l1al vCDn .E-Mail . Fax Number ", :'. ;+9' b . '··5······ p.2 -' ...... , .. .. ....... ' woo WtA " . EVENT INFORMATION ., . ...' ... , ....... '''W<n Whl=Ci ~Q"" ~~~~--~------------~-- Cellular Number . ~ '. \ Cf\ "90~' St. (R2dn (J) \-~ --:--:-:---:-=:~=--=-:-:-...,..----:-_ Event Location Anticipated Attendance Type of Event all costs and fees associated with this request form prior to the service date(s): Date D APPROVED AS PRESENTED D DENIED NO, Office: :x:: NO. Radio: f) ::x: --......:::...-"---- D APPROVED WITH CONDITION NO. Hours 11 ~f'" ~ ~ :OMMENT: --~~7}T7~----------------~----__ -'~~~~ 'OLICE DEPART. M .. lE~' , ,...-~ / Estimated I q I 0 0 ;IGNATURE /'//7-';1 DATE)// J //Z-. TotaICost$(oQ. 11-16 Stout-Tate, Maria From: Sent: To: Subject: Corbin, Larry P. Thursday, May 17, 20129:31 AM Stout-Tate, Maria RE: Attachments: image001.jpg Maria, The revised total cost to cover this event with 2 officers will be as follows: 2 officers @ $40.00 per hour each 12 hours per officer(24hrs total): $960.00 Lieutenant Larry Corbin UniforlJ1 Patrol Division South Miami Police Department PH 305-663-6351 FAX 305-663-6353 Maria May 16, 2012 3:21 PM . Subject: RE: ~~. " Page 1 of2 Can you provide me with the changes so that I can add it as back up for the resolution? Thank you. Maria Elena CITY OF SOUTH MIAMI PUBLIC WORKS DEPARTMENT 4795 SW 75 th Avenue, Miami, FI 33155 (305) 668-7205 Fax (305) 668-7208 Application to Conduct A Special Event Fun~tion on Public ~ight-of-Way South Miami Flo I" I d • ~d ~lliP 2001 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. Contact Information: lOr2ILI\') CcmmU() \-tvt \-b;p/4D l Business/Organization Name Ij (' Authorized Representative Name :::roS\ SWC{8rd hJf2 0' rY\Omi ~F_L=--__ 3314~. Business/Organization Address City State Zip Code Phone Number Fax Number E-Mail Event Information: Event Name ~a2t:..1) CcmrnJn~ i-la I \-.\Qo 1-\ h 'FC\ u:2. . Project Location -=to;-tf S-\i2ill""\ CO old .Av.2rue crd l.Q\ <;-\ -1\J~ Event Oate(s) (0180 lIa Event Oay(s) ScrtuQ. cb~ Type of Event l-lectl-!h 1'01 Q Event Start Time \0: -3::) Eflpm) Event End Time . ,:<{ : 2() . (am ~ Anticipated Attendance t3:X) Event Setup Time 5 ~ pm) Breakdown Time 8 (am I@ Total Duration (include setup) I 5 y-gs I HEREBY REQUEST A PERMIT FOR THE FOLLOWING: Anticipated effects on vehicular and pedestrian traffic during Project Maintenance of traffic provisions are specific (include sketch if necessary): The f~wing documents have been submitted with this permit application: [0' Site plan I sketch of event. Clearly define boundaries and linear foot of road closures. DMaintenance of Traffic (MOT) for vehicular and pedestrian traffic during event. "In signing this application, I understand that separate City and unty permits may be required for this project. Furthermore, I am aware that I am responsible for ensuring that the project is completed in acco~ ce ith the plans and eCI' ations as stipulated in the permit approval conditions. As well as acknowledge that any right-or-way closures will require at e tone off-d office I lic works employee and barricades. 11 ~~. ~_---'-~~~. _ 5/'1/ Zoi.2. DATE FOROFFI'bE'USESONLY: Permit No: .... Approved! "C By Date s:: Permit Fee Comments Disapproved 0 u 12-16 Permit Fee Applicant: Larkin Hospital Ordinance Item PERMIT FEES TEMPORARY FULL ROAD AND SIDEWALK CLOSURE No single lane roadway closure permitted. ' Excludes city events and events funded by the city. Per linear. FLof road, rounded to the next higher whole number in ft.,per day TEMPORARY SIDEWALK CLOSURE Permit requires French barricades along curb or EOP.* TEMPORARY STAGING AREA, CRANE, TRAILER, TRUCK ON THE RIGHT· OF·WAY 'For special event 8 hr. period max., incl. set up time. Excludes city events and events funded by the city. Measurement Minimum permit fee Permit extension fee, for 60 day period 0~50 LF 5i~300 LF Every additional 50 LF or fraction Maximum pormit roe Each 25 SF or fraction Maximum permit fee Flat Fee per day for first 5 days Every five days or fraction thereof after Permit#: Date: Fee $150 $150 $1,500 $2,SOO $1;000 S10,000 $0.25 $75 $10,000 $200 $300 5/16/2012 Total Actual Unit Permit Fee $0.00 $0.00 SO.OO $0.00 SO,OO SO.OO 1000 $250.00 $0,00 $0.00 $0.00 $0.00 Permit Fee Total: $250.00 '~)f~ :,,~ " """ ' ""', :",', 121 ;-"'" -.:t~:,'" ; : !"1lIi;i;i;~ ,~,. A4:--; CITY OF SOUTH MIAMI PARKING DIVISION 6130 Sunset Drive, South Miami, FI33143 (305) 668-2512 Fax (305) 663-6346 Parking Stalls/Meters Rentals Application South Mlanll Flo rid a. b~·'i!I (li'iit , 2.001 Pursuant to Section 15 C-l (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". ld2\6n CorYYY'Un\~ tldPI+oL :Sdo(()~ NJro Business/Organization Name Applicant Nam FL Business/Organization Address City State Zip Code J 1lfD@\o(2Xj() roSRi-bl v cvn Phone Number Fax Number E-Mail Name of Event: loP--t-() Co1\rrun lB Hcredol r~~ype of Event: ~O l-4h roiQ' Purpose for utilizing parking meters: . ~.1--~. .. Number of On/Street curbside spaces requested: 3 Number of Day's Start _---=1.'-=-_curbside spaces desired: ----' __ Time: End ~OD Time: D ~ ~~~~~~~~~~~~~~-4~~--~~~--4-~~~~~~~4 t ~ ...s ~----r---------------~~~~~~~~~~~~~ I:s <:;) ~ ~ ________ ~ ________________________________ ~~ ____ ~~~~~~~~~ __ ~V) (If necessary, please attach additional sheets) this applicant will be revie amend or supplement thi IW , P' FQROFFIGE,USESONLY: Permit No: ________ _ D DENIED Cll APPROVED AS PRESENTED D APPROVED WITH CONDITION NO. Meter Days: \ ::x:: NO. Meter: 2J 1. :x Daily Fee:~"~l 0 I{) ~ Comment: ~ S _ I f.r I Z h '500. o~ PARKING DI'V'IsTON SIGNATtJRE DATE Estimated Total Cost 14-16 ~1 G. -r:c:e.. N \J fY' 1:£ \z..s F'«.-." .. ~".. - "10 s, CITY OF SOUTH MIAMI Public Works Department Event Cost Estimate Submitted To: Maria Stout-Tate Name of Event: Larkin community Hospital Health Fair Event Date (s): June 23, 2012 Personnel: • Saturday, June 23, 2012 10:00 AM to 5:00 PM Two employee's FICA Materials: • $560.00 $ 42.84 $602.84 Eguipments: Cost: • Barricades $ Grand Total: $602.84 Date Prepared: Approved by: Public Works I t t i JE o\vn & rown ! J lINSURANCE(. May 21, 2012 City of South Miami 6130 Sunset Drive South Miami, FL 33143 Re: Larkin Community Hospital, mc. To Whom It May Concern: Brown It B:tow:a of FlonM, Inc. Miami Dlrilion 14900 NW 79th Court. Suite m Miami Lake,. FL 33016-5869 (305) 364-7000 Fa>< (305) 714·4401 The General Liability policy for Larkin Community Hospital, Inc. is scheduled to renew on 06/2112012. 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 06/23/2012. Please feel free to contact out office with any questions. Sincerely, 4wn d Brown of Florida, Inc Miami Division A~ ---.., Nonnan Morris Senior Vice President LARKI-5 OP 10' P4 ACc:JRD~ CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDNYYY) ~. 05115/12 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 305-364-7800 CONTACT NAME: BROWN & BROWN OF FLORIDA INC 305-714-4401 rA~gN9n Fyt . J FAX 14900 NW 79th Court Suite#200 iAlC No): Miami lakes, FL 33016-5869 E-MAIL ADDRESS: Norman Morris INSURER(S) AFFORDING COVERAGE NAIC# INSURERA:Darwin Select Insurance Co 24319 INSURED Larkin Community Hospital,lnc INSURERB:RLllnsurance Company. 13056 Attn: Ms. Berges INSURER C : Retail First Insurance Co. 10700 7031 SW 62 Avenue South Miami, FL 33143 INSURERD: INSURERE: INSURER F' COVERAGES CERTIFICATE NUMBER' '. REVISION NUMBER' 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. '~f: TYPE OF INSURANCE I~~.,o,; ~~~ POLICY NUMBER POLICYEFF I ,~pLlCY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,OOO,OOC - A X COMMERCIAL GENERAL LIABILITY X 03067568 06/21/11 06/21/12 ~RE'~lS'H YE~t=o~r~ence) $ 100,OOC I CLAIMS-MADE W OCCUR MED EXP (Anyone person) $ 5,OOC PERSONAL & ADV INJURY $ - GENERAL AGGREGATE $ 3,OOO,OOC - GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ !Xl POLICY n ~!}f?T n LOC EBl $ 1,OOO,OOC AUTOMOBILE LIABILITY fE~~~~d~~I~'NGLE LIMIT $ 3,OOO,OOC I--CAP9502321 04/15/12 04/15/13 B X ANY AUTO BODILY INJURY (Per person) $ I--ALL OWNED r---SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ I--Z NON-OWNED rp~~~~~J.;;,gAMAGE ~ HIRED AUTOS AUTOS $ PIP $ 10,OOC ~ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ 500,OOC A EXCESSLIAB CLAIMS-MADE 03067569 06/21/11 06/21/12 AGGREGATE $ 500,000 OED I X I RETENTION $ 25000 $ WORKERS COMPENSATION X I WC STATU-I IOTH- AND EMPLOYERS' LIABILITY TORY LIMITS ER YIN 500,OOC C ANY PROPRIETORIPARTNERlEXECUTIVE 0 52039708 02115/12 02115/13 E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N/A SOO,OOC (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 500,OOC A Professional Liab. 03067568 06/21/11 06/21/12 EachClaim 1,OOO,OOC Aggregate 3,OOO,OOC DESCRIPTION OF OPERATIONS I LOCA nONS I VEHICLES (Attach ACORD 101, Addiiional 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_ CERTIFICATE HOLDER CANCELLATION 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 REPRESENTA nVE I ",,-_.~f':;;;;Z:: ..,--!};~~~ © 1988-2010 ACORD CORPORATION. All nghts reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD CASH RECEIPT City of South Miami FUND ------__ _ "0r-f>",'·' :'.- ~'", ,. ';,': , VAUD ONLY WHEN BEARING OFFICIAL REGISTER VALIDATION CASH. ___ _ CHECK No.IG27~ DATE: ~IIQ- ACCOUNT NO_-----_ . CASHIER ~ MAY 2i 2012 pAGE 1 :. 5/21/12 IHEALTH FAIR TOTALS 2812.84 GROSS AMOUNT 2812.84 4::' DATE 5/22/12 DISCOUNT AMOUNT 2812.84 NET AMOUNT 2812.84 . J I . la-' I '--~ . III ~ b 27 2 sll·~\ I:O{; {;O •• 3 Ii 21: .0277.b.0 Sill