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HomeMy Public PortalAbout13-8562 Florida Municipal Insurance Trust $31,839 Sponsored by: City Manager RESOLUTION NO. 13-8562 A RESOLUTION OF THE CITY COMMISSION OF THE CITY OF OPA-LOCKA, AUTHORIZING THE CITY MANAGER TO PAY FLORIDA MUNICIPAL INSURANCE TRUST ("FMIT") $31,839 FOR AUTOMOBILE GENERAL LIABILITY, PROPERTY AND ALLIED COVERAGE, AND WORKERS' COMPENSATION INSURANCE, PAYABLE FROM ACCOUNT NO. 18-513451; PROVIDING FOR INCORPORATION OF RECITALS; PROVIDING FOR AN EFFECTIVE DATE WHEREAS, the City has an insurance contract with the Florida League of Cities that covers the City's automobile, general liability, Property and Allied Coverage, and Workers' Compensation, Florida Municipal Insurance Trust("FMIT"); and WHEREAS,the City Commission of the City of Opa-locka desires to authorize payment to FMIT, in the amount of$31,839.00; and WHEREAS, payment is due March 1, 2012, and the City Commission of the City of Opa-locka, desire to authorize the City Manager to pay FMIT for automobile and general liability, Property and Allied Coverage, and Workers' Compensation. NOW, THEREFORE, BE IT DULY RESOLVED BY THE CITY COMMISSION OF THE CITY OF OPA-LOCKA, FLORIDA: Session 1. The recitals to the preamble herein are incorporated by reference. Session 2. The City Commission of the City of Opa-locka directs and authorizes the City Manager to make payment to Florida League of Cities, FMIT, for automobile, general liability, Property and Allied Coverage, and Workers' Compensation, in the total amount of $31,839.00,payable from Account No. 18-513451. Session 3. This resolution shall take effect immediately upon adoption. PASSED AND ADOPTED this 13th day of March, 2013. Resolution No. 13-8562 YRA AYLOR MAYOR Attest to: C.i (4-60/1)-71 J�f nna Flores R y Clerk Approved to fo• and legal sufficiency: 10 I , 41/0 J���n• . Geller EE SPOON MARDER PA •ity Attorney Moved by: VICE MAYOR KELLEY Seconded by: COMMISSIONER HOLMES Commission Vote: 4-0 Commissioner Holmes: YES Commissioner Johnson: OUT OF ROOM Commissioner Santiago: YES Vice-Mayor Kelley: YES Mayor Taylor: YES Opp-ioC,rq, . off �to, °I `��onnti City of Opa-Locka Agenda Cover Memo Commission Meeting Item Type: Resolution Ordinance Other Date: March 13,2013 xx (EnterX in box) Fiscal Impact: Ordinance Reading: 1st Reading 2nd Reading (Enter X i n box) Yes No (Enter X in box) Public Hearing: Yes No Yes No XX (Enter X in box) X Funding Source: (Enter Fund&Dept) Advertising Requirement: Yes No (EnterAcctNo.) Gen-Govt (Enter X in box) XXX Insurance _18-513 451 Contract/P.O. Required: Yes No RFP/RFQ/Bid#: (Enter X in box) XXX N/A Strategic Plan Related Yes No _ _ Strategic Plan Priority Area: Strategic Plan Obj./Strategy: (list the (Enter X in box) specific objective/strategy this item will address) Enhance Organizational Q XXX Bus.&Economic Dev p Public Safety Quality of Education El Qual.of Life&City Image El Communcation L7 Sponsor Name Department: Kelvin Baker City Manager Short Title: A resolution of the City Commision of the City of Opa-locka, Florida authorizing the City Manager to pay$31839.00 for automobile,general liability, Property and Allied Coverage, and Workers Compensation Insurance from account#18- 513451. Staff Summary: Staff recommends approval to pay Florida League of Cities. Proposed Action: Approval for payment of automobile and general liability deductibles. Attachment: Copy of Agenda Item, FMIT Invoice 0.?" - J, OQ/ to, ( 9 (1 1g). PaCigi Amick(/' Memorandum TO: Mayor Myra L. Taylor Vice-Mayor Joseph L. Kelley Commissioner Timothy Holmes Commissioner Dorothy Johnson Commissioner Luis Santiago 1 FROM: Kelvin L. Baker City Manager'( DATE: February 25, 2013 RE: Agenda Item —Payment of Florida Municipal Insurance Trust Invoice for City Insurance, Final Audit for 2011/2012 Fund Year Request: A RESOLUTION OF THE CITY COMMISSION OF THE CITY OF OPA- LOCKA, FLORIDA AUTHORIZING THE CITY MANGER TO PAY 531,839.00 FOR AUTOMOBILE, GENERAL LIABILITY, PROPERTY AND ALLIED COVERAGE, AND WORKERS' COMPENSATION INSURANCE FROM ACCOUNT#18-513451. Description: Resolution authorizing the payment of Florida Municipal Insurance Trust for automobile, general liability, Property and Allied Coverage, and Workers Compensation insurance from Account#18-513451, for fund year 2011-2012 for the amount of$31,839.00. Financial Impact: $31,839.00 Implementation Timeline: Payment is due 3/1/2013 Legislative History: N/A Recommendation(s): Staff recommends approval for payment of vendor. Analysis: Staff is requesting payment based on our insurance contract with the Florida League of Cities. Attachments: Invoice from Florida Municipal Insurance Trust. PREPARED BY: Wonda Cooper, Human Resources Director c ∎-• • gr E Of C'�Fs l Florida Municipal Insurance Trust (FMIT) Z Final Audit for the 11/12 Fund Year DE 'ANENT OF INSURANCE ... EINANCIAL SERVICES FM1IT# 0435 Invoice Date: 1/30/2013 Due Date: 3/1/2013 ATTN:Shirley Freeman Please make check payable to: City of Opa-Locka Florida Municipal Insurance Trust 780 Fisherman Street,4th Floor P.O.Box 1757 Opa-Locka,FL 33054 Tallahassee,FL 32302-1757 A.tdit Policy Summary General Liability Auto Liability Auto Physical Property Workers Total Damage Compensation Gr ass Premium $227,931.00 $64,728.00 $18,345.00 $89,287.00 $239,029.00 $639,320.00 Incentive Credit ($18,404.00) $0.00 $0.00 S0.00 ($25,626.00) ($44,030.00) Total Net Premium $209,527.00 $64,728.00 $18,345.00 $89,287.00 $213,403.00 $595,290.00 Payment History Payment Received On 9/28/2011 ($138,928.75) Payment Received On 12/27/2011 ($141,507.42) Payment Received On 4/12/2012 ($141,507.41) Payment Received On 7/2/2012 ($141,507.42) Total Balance Forward ($563,451.00) Final Audit Installment Due or Refund Balance Due by 3/1/2013 $31,839.00 c_.) . ;-T rt (C.)i?'Y i'le, rc s,Irn with ywur p: yM OW. y lJ 1 i ^.: : `f For your records w ash 0011E c Florida Municipal Insurance Trust (FMIT) Final Audit for the 11/12 Fund Year DE PARTMENT OF INSURANCE AND FINANCIAL SERVICES FMIT# 0435 Invoice Date: 1/30/2013 Due Date: 3/1/2013 ATTN:Shirley Freeman Please make check payable to: City of Opa-Locka Florida Municipal Insurance Trust 780 Fisherman Street,4th Floor P.O.Box 1757 Opa-Locka,FL 33054 Tallahassee,FL 32302-1757 Audit Policy Summary • General Liability Auto Liability Auto Physical Property Workers Total Damage Compensation Gross Premium $227,931.00 $64,728.00 $18,345.00 $89,287.00 $239,029.00 $639,320.00 Incentive Credit ($18,404.00) $0.00 $0.00 $0.00 ($25,626.00) ($44,030.00) Total Net Premium $209,527.00 $64,728.00 $18,345.00 $89,287.00 $213,403.00 $595,290.00 • Payment History Payment Received On 9/28/2011 ($138,928.75) Payment Received On 12/27/2011 ($141,507.42) Payment Received On 4/12/2012 ($141,507.41) Payment Received On 7/2/2012 ($141,507.42) Total Balance Forward ($563,451.00) • Final Audit Installment Due or Refund Balance Due by 3/1/2013 $31,839.00 PINK COPY• Please return with your payrrl1znt WHITE COPY-For your records FLORIDA MUNICIPAL INSURANCE TRUST Final Audit Summary for Fund Year 2011-2012 Period: 10/1/2011 to 10/1/2012 C ity of Opa-Locka EMIT 0435 COVERAGE TYPE PREMIUM General / Professional Liability - $ 209,527 For coverage and limit of liability, refer to the 2011-2012 FMIT declaration pages and schedules Automobile - $ 83,073 Audited vehicle schedule is attached For coverage and limit of liability, refer to the 2011-2012 EMIT declaration pages and schedules. Property and Allied Coverage - $ 89,287 For coverage and limit of liability, refer to the 2011-2012 FMIT declaration pages and schedules. Workers' Compensation - $ 213.403 Audited payroll schedule is attached For coverage and limit of liability, refer to the 2011-2012 FMIT declaration pages and schedules. Changes to your coverage or schedules will be reflected on the attached endorsements if applicable FLORIDA MUNICIPAL INSURANCE TRUST GENERAL/PROFESSIONAL LIABILITY COVERAGE AGREEMENT DECLARATIONS I. DESIGNATED MEMBER Agreement No.: FMIT #0435 City of Opa Locka II. Government Description Municipality FxEN_ ` k{`' III. CCVERAGE PERIOD From October 1, 2011 to October 1, 2012 12:01 A.M. Standard Time at the address of the Designated Member. Premium Basis _ Deductible/T .e Limit Net Premium IV. General/Professional Liability I $25,000 DSL $1,000, 000 1 $209,5271 Payroll : , 5,411,872 f I 1 . General Liability I a. Broad Form Property Damage $25,000 DSL Per Form, Included' b. Extra Contractual Legal Expense N/A $25, 000 Included c. Fire Legal Liability $25,000 DSL. $250, 000 Included C. Medical Attendants /Medical $25,000 DSL $1,000, 000 Includedi Directors' Malpractice Liability II I 2 . Errors and Omissions Liability I Y I $25,000 DSL $1, 000, 000 Included a. Employment $25,000 DSL; $1,000,000 Included Practices Liability k I b. Employee Benefits Program $25,000 DSL $1, 000,000 Includedi Administration Liability 3 . Law Enforcement $25,000 DSL $i,000,000; Included Full Time with Arrest Powers: I�I 49 Full Time without Arrest Powers: 21 Part Time without Arrest Powers: 41 Clerical : , 9 V. This Agreement includes these endorsements and schedules: See Schedule A VI. ESTIMATED ANNUAL PREMIUM Normal Incentive Net Premium Credit Premium Florida Municipal Insurance Trust (FMIT) $227,931 $18,404 $209,527 Florida League of Cities Sponsored Insurance Programs Since 1977 THIS DECLARATIONS AND THE SUPPLEMENTAL DECLARATIONS,TOGETHER WITH THE COMMON CONDITIONS,COVERAGE FORM(S)AND ENDORSEMENTS COMPLETE THE ABOVE NUMBERED AGREEMENT. FMIT GL DEC 1008 Original X/::120: Automobile Schedule City of Opa-Locka, FMIT#0435 10/01/2011 - 10/01/2012 Veh it EfI Date Exp Date City 8 Year Make Description ID 8 Cost New Code Liab PIP Med Pay UM Comp Ded SP Ded Coll Ded Phy Dmg Total Pram 0 10/1/2011 1011/2012 HIRED AUTOS $0 6619 $41 $0 $0 $0 n/a n/a n/a $0 $41 0 1011/2011 10/1/2012. ' . NON OWNED AUTOS, $0 6601': $41 $0 • $0 - i$0,. . •n/a n/a n/a $0 • . $41. 1 101112011 101112012 1997 KAWASAKI MOTORCYCLE 1714 $20,000 7986 $273 $0 $0 $0 n/a 0 31000 $164 $437 • - 2'1D/1/2011 611112012. •. 1886 MACK GARBAGE TRUCK 2773 ' $35,000• 21450 $300' • $8.:'` $0 '$0 "nia n/a •• . n/a $53 $367 3 10/112011 6111/2012 1986 MACK GARAGE TRUCK 2774 $35,000 21459 $306 $8 $0 $0 nla n/a n/a $53 $367 4 10/112011 ' 6/1112012 1987 INTERNATIONAL '' GARBAGE'TRUCK .:;6623 $36000 '•'21459. ' $306 • $8, . ..$0, .`$0 n/a ,n/a Na'` $53: $367 5 1011/2011 6/1112012 1994 FORD CROWN VICTORIA 9599 $18,000 7398 $222 $17 $0 $0 nla n/a n/a $67 $306 6101112011' 6111/2012 '; 1994;FORD :-:, CROWN VICTORIA 9561 $18 000 7398 $222'. $17''" $0` i'$0 n/a '-:n/a n/a •$67 $306 7 101112011 6!11/2012 1994 FORD CROWN VICTORIA 9569 $18,000 7398 $222 $17 $0 $0 n/a n/a n/a $67 $306• 8 101112011 6111/2012 1$94`FORD . CROWN VICTORIA 13$3; $18,000' ,. 7398-': $222... $17 $0 550 n/a n/a Ma $67 $30 • 9 10/1/2011 6/11/2012 1994 FORD CROWN VICTORIA 1369 $18,000 7398 $222 $17 $0 $0 n/a n/a n/a $67 5306• 10.10/1/2011 r ,6/1112012 ';.' 1994 FORD , . CROWN VICTORIA 1364' • $18,000 '7398 $222,.: $17 $0 $0 nla . nia' -' ilia $67. $306. 11 1011/2011 6111/2012 1994 FORD CROWN VICTORIA 1368 $18,000 7398 $222 $17 $0 $0 n/a n/a n/a $67 $306 :I2 10/1/2011 €11112012 •` :..•.1995 FORD : PICKUP . .1945 • $21000: • 13 10/112011 1011/2012 1996 FORD CROWN VICTORIA 0340 $19,000 7398 $321 $25 $0 $0 $1000 n/a $1000 $96 $442 , . 14 10/1/2011 10/1/2012 ''' 1907.FORD, "PICKUP 8938..` •$2',000 '01499'' 5340. $12. ' '$0: ' $0 $1000 n/a $1000 $64 $416 15 10/112011 4/3/2012 1997 FORD PICKUP 8939 $21,000 01499 $171 $6 $0 $0 n/a n/a n/a $32 $209•_16'101112011 6/11/2012 1997 FORD PICKUP 8940 $21,000• 01499 i $235 • $8'•? '$Di $0 n/a • ''n/a n/a $45 • • $289 17 10/1/2011 6/11/2012 1997 FORD PICKUP 8937 $21,000 01499 $236 $8 $0 $0 n/a n/a n/a $45 $289 ' '18•10/112011 ' 413/2012 .' 1994 FORD • CROWN VICTORIA 9552 $18,000' 7398 . $152' $13 $0 $0 n/a n/6 n/a $48 $223 19 101112011 6111/2012 1997 FORD RANGER 0647 $21,000 01499 $236 $8 $0 $0 n/a n/a n/a $45 $259 ,,20 101112.011 ",179i2012 1993'CHEVROLET 4 DR POLICE CAR 6185'-` $16,000 `'7911 $186:' $15'' • $0 <.'$0: ' nla nla • ' n/*a • $47... $248•21 101112011 1011!2..., ...... .-. . __ :._._. 012 1997 DODGE 15 PASS VAN 4516 $21,000 5882 $505 $0 $0 $0 $1000 n/a $1000 $55 $560 22 101112011 6111/2012 1982 FORD 'GARBAGE TRUCK • ; • 0564 $34,000 .. 21459 '$306 $6: $0 .`'•$0 n/a • •n/a Ma $53 $367 Page 1 of 9 r Automobile Schedule - - - -- City of Opa-Locka, FMIT#0435 10/01/2011 -10101/2012 Vim-/# Elf Date Exp Date City# Year Make Description ID# Cost New Code Liab PIP Med Pay UM Comp Ded SP Ded Coll Ded Phy Ding Total Prem 23 10/1/2011 6/11/2012 2000 STERLING GARBAGE TRUCK 7353 $50,000 21459 $306 $8 $0 $0 n/a n/a n/a $72 $386 VA•Y4 1411/2011 6/1112fl12 1984 DODGE- _. . ;. 01499 $236 $8 ' . --$0 n/a 1.844.: $21$45 $289 N $0 n/a 15 1011/2011 6/11/2012 2000 MACK GARBAGE TRUCK 9604 $50,000 31459 $344 $8 $0 $0 n/a n/a n/a $70 $422 26 1011/2011_ 6/1112012: 2000 MACK . GARBAGE=TRUCK 9805 $50,000. 31459 $344' $8 $p $0 Iva , -.nia n1a $70 $422 • 27 1011/2011 6/11/2012 1986 FORD F350 TRUCK 9566 $21,000 01499 $236 $6 $0 $0 nla n/a nla $45 5289 28 1011/2011 •' 6/1112012 •" 1987 FORD - AEROSTkR` 01499 $235 $6 $0 $0. n/a nra• 66n a. . '$45 $289 $21 00. 29 10/1/2011 6/11/2012 1999 FORD F150 TRUCK 1946 $21,000 01499 $236 $8 $0 $0 n/a nla n/a $45 $289 30 10/1/2011 6/11/2012 1986 INTERNATIONAL'`, GARBAGE TRUCK%; ' •4564'. SAO;000 '' 21459 $306;. $8 $0 $0 nla . n/a n/a $53 $367 31 10/1/2011 4/3/2012 1986 INTERNATIONAL GARBAGE TRUCK 5574 $40,000 21459 $222 $6 $0 $0 n/a n/a n/a $38 $265 32 10/112011 611112012': , 2000 POLICE CAR 4 'DOOR, ` 7911 $256 $20 $0 '.,• $0 n/a n/a 'n/a 7A$65 $341 33 10/1/2011 4/3/2012 1997 POLICE CAR CROWN VICTORIA 8220 $17,000 7911 $186 $15 $0 $0 n/a n/a n/a $47 $248 34.10/1/2011 ' 41312012 1996'POLiCE CAR. - 4"AOOR 3155 $17,000 • ' 7911 $188• •• $15 .$0 $47 $248 35 10/1/2011 6/11/2012 1992 POLICE CAR CROWN VICTORIA 9611 $17,000 7911 $256 $20 $0 $0 n/a n/a n/a $65 $341 36 101112611 6111/2012 1994'POLICE CAR . .,.- , CROWN VICTORIA ' '7361 $17,000 7911.' $256. $20 '$0 $0 '• n/a n/a Via, . :. _._....:. .-°- . - $65 • $341 37 101112011 6/11/2012 13969 2002 FORD CROWN VICTORIA 9143 $21,450 7398 $222 $17 $0 $0 n/a n/a n/a $74 $313 ' 38 10/1/2011 10/1/2012' 13970• 2002 FORD CROWN VICTORIA 6895' $21,556• ' `.' 7398 $321 $25 $0 $0 $1000 n/a $1000 $106 $452 39 10/112011 10/1/2012 13971 1991 FORD .2 CROWN VICTORIA 6815 $21,672 7398 $321 $25 $0 $0 $1000 n/a $1000 $106 $452 4D 10/1/2011 6/11/2012 13979` 2000,FORD CROWN VICTORIA - l :-:.._... 0417 $21,560 . ., :: 7398 3222 $17 $0 $0 n/a n/a . 'n/a $74 $313 ,._ 41 1017/2011 6/11/2012 13978 2000 FORD CROWN VICTORIA 0419 $21,680 7398 $222 $17 $0 $0 n/a n/a nla $74 $313 • 42 .10/1/2011 6/11/2012` 13991 ' 2002 FORD CROWN VICTORIA ` ,.__ 7398 $222 $17 $0 $0 n/a n/a. 6236 n/a $20,300 $313 9._5 43 10!112011 6/11/2012 1994 FORD � CROWN VICTORIA $18,000 9565 7398 $222 $17 $0 $0 n/a n/a n/a $67 $306•44 10/1/2011 4/3/2012: 1994 JEEP'- CHEROKEE:' ' ' ' 1001 • 315,500 ._. 7398° • $162 $13 ' ...' $0' . $0 -' n/a t' nia n/a $48 $223` 45 10/1/2011 10/1/2012 ' - 1999 DODGE RAM 2500 2171 $26,516 01499 $340 $12 $0 $0 $1000 n/a $1000 $76 $428 46 10/1/2011 10/1/2012 1991 CHEVROLET r STEP VAN ' 0768 $14,974 . 01499 $340 $12 $D • $0 $1000 : nia $1000 - $49 $401 Page 2 of 9 Automobile Schedule City of Opa-Locka, FMIT#0435 10/01/2011 -10/01/2012 Veh# Eft Date Exp Date City# Year Make Description ID# Cost New Code Liab PIP Med Pay UM Comp Ded SP Ded Coll Ded Phy Dmg Total Pram 47 101112011 4/312012 1995 FORD 4 DOOR 3875 $18,810 7398 $162 $13 $0 $0 n/a n/a n/a $48 $223 48 10/112011 4/312012 1991 FORD F350 TRUCK 8926 $21,000 01499 $171. $6 $0 , $0 n/a n/a n/a $32 $209 49 10/1/2011 6/11/2012 1995 CHEVROLET CAPRICE 9597 $24,540 7398 $222 $17 $0 $0 n/a n/a n/a $74 $313•50 10/1/2011 6/11/2012 1994 FORD CROWN VICTORIA 3152 $18,000 7398 $222 $17 $0 $0 n/a nla nla $67 $306 51 10/1/2011 6111/2012 15596 2004 FORD 15 PASS VAN 6348 $21,230 5882 $350 $19 $0 $0 n/a n/a n/a $45 $414 52 1011!2011 6N1/2012 1992 FORD PASS VEHICLE 9615 $16;000 7398 $222 $17 $0 $0• nla 'n/a n/a $59 $298 53 10/1/2011 10/1/2012 1978 CADILAC 4 DOOR 1788 $15,500 7398 $321 $25 $0 $0 $1030 n/a $1000 $96 $442 54 1011/2011 6/11/2012 168646146 MINIBUS 1819. $15,500. 5881 $306 317 $0 • $0 n/a n/a n/a $33 $356 55 10/112011 6/11/2012 1987 FORD RANGER 1496 $11,500 01499 $236 $8 $0 $0 n/a n/a n/a $34 $278 58 10/112011 6!1112012 1968 KAWASAKI MOTORCYCLE 9648 $15,000 7986 $189 $0 $0 $0 n/a n/a n/a $92 $281 57 10/1/2011 10/1/2012 1989 CHEVROLET CAMARO 1104 $14,500 7398 $321 $25 $0 $0 $1000 n/a $1000 $86 $432 58 10/1/2011 10/112012 1988 KAWASAKI MOTORCYCLE 9631 $15;000 7986 $273 $0. $0 $0 n/a 1000 $1000 $132 $405 59 10/112011 10/1/2012 1991 FORD PICKUP 9340 $12,500 01499 $340 $12 $0 $0 $1000 n/a $1000 $49 $401 60 1011/2041• 6(11/2012 1993 HARLE■•DAVIDSON MOTORCYCLE 6654 $16,500 7986 $189 $0 $0 $0 n/a n/a n/a $100 $289 61 10/1/2011 6/1112012 1993 HARLEY DAVIDSON MOTORCYCLE 6685 $16,500 7986 $189 $0 $0 $0 n/a n/a n/a $100 S289 62 10/1l2011 4/3/2012 1994 FORD CROWN VICTORIA 9553 518,000 7398 $162 $13 $0 $0 n/a n/a n/a $48 5223 63 10/1/2011 6/11/2012 1994 FORD CROWN VICTORIA 9556 $18,000 7398 $222 $17 $0 $0 n/a n/a n/a $67 $306 64 10!1/2011 6/11/2012 1994 FORD CROWN VICTORIA 9559 $18,000 7398 $222 $17 0 $0 n/a n/a. n/a $67 $306 65 10/1/2011 6/1112012 1994 FORD CROWN VICTORIA 9877 $18,000 7398 $222 $17 $0 $0 n/a n/a n/a $67 $306 '66 10/1/2011 4/312012 1995 FORD VAN 7361 $20,000 01499 $171 $6 $0 $0 n/a n/a n/a $29 $206 67 10/1/2011 611112012 1995 FORD VAN 2334 $20,000 01499 $236 $8 $0 $0 n/a n/a n/a $40 $284 68 10/1/2011 1011/201'2 1996 FORD CROWN VICTORIA 4545 $21,713 7398 $321 $25 $0 $0 $1000 n/a $1000 $106 $452 69 10/112011 10/1/2012 1996 FORD CROWN VICTORIA 7718 $21,713 7398 $321 $25 $0 $0 $1000 n/a $1000 $106 $452 i6.--16/1110-11 10/112012 1996 FORD CROWN VICTORIA 9875 521,713 7398 $321 $25 $0 $0 $1000 nla $1000 $106 $452 Page 3 of 9 Automobile Schedule City of Opa-Locka, FMIT#0435 10/01/2011 - 10/01/2012 Veh# Eff Date Exp Date City# Year Make Description ID# Cost New Code Liab PIP Med Pay UM Comp Ded SP Ded Coll Ded Phy Dmg Total Prem 71 10)1/2011 10/1/2012 1996 CHEVROLET LUMINA 5755 $17,000 7398 $321 $25 $0 $0 $1000 n/a $1000 $96 $442 72 10/1/2011 4/312012 1996 CHEVROLET LUMINA 6892 $17,000 7398 $162 $13 $0 $0 nla n/a n/a $48 $223 73 10/1/2011 10/1/2012 1997 DODGE VAN 3952 $22,000 01499 $340 $12 $0 $0 $1000 n/a $1000 $64 $416 74 10/1/2011 6/11/2012 1998 FORD CLUBWAGON 4517 $13,500 7398 $222 $17 $0 $0 n/a n/a n/a $59 $298 75 10/1/2011 10/1/2012 1998 FORD CROWN VICTORIA 3389 $22,520 7398 $321 $25 $0 $0 $1000 nla $1000 5106 $452 76 10/1/2011 10/1/2612 1998 FORD CLUBWAGON 4520 513,500 7398 $321 525 $0 $0 $1000 n/a $1000 $86 $432 77 1011/2011 10/1/2012 1998 FORD CLUBWAGON 4516 $13,500 7393 $321 $25 $0 $0 $1000 n/a $1000 $66 $432 78 10/1/2011 10/1/2012 2000'STERLING AQUATECH 6405 $40,000 21499 $356 $12 $0 ,$0 $1000 n/a $1000 $57 8425_ 79 10/112011 6/11/2012 . . 2000 FORD CROWN VICTORIA 9113 $21,450 7398 $222 $17 $0 $0 n/a n/a n/a $74 $313 80 10/112011 10/1%2012 2000 DODGE VAN' 1(455 816;500 01499 $340 512 $0 '.$0 $1000 n/a $1000 $57 $409 81 10/1/2011 6/11/2012 2004 MACK DUMP TRUCK 9993 $71,828 31479 $229 $8 $0 $0 n/a n/a n/a $66 $303 82 18/1/2011 6/11/2012 2004 FORD F450 TRUCK 6410 536,500 21499 $247 $8 $0 $0 n/a n/a n/a $47 $302 83 10/1/2011 6/11/2012 2004 FORD 4 DOOR 9254 $27,000 7398 $222 $17 $0 $0 n/a n/a n/a $92 $331 64 1011/2011 6/11/2012 2004 FREIGHTLINER TRUCK 7390 565,000 '34499 $344 $8 $0 $0 n/a n/a n/a $77 $429 85 10/1/2011 10/1/2012 16485 2005 DODGE STRATUS 1926 $21,558 7398 $321 S25 $0 $0 $1000 n/a $1000 $115 $461 86 10/1/2011 1011/2012 16486 2005 DODGE STRATUS , 1927 $21,558 7398 $321 $25. $0 $0 $1000 n/a $1000 $115 $461 87 10/1/2011 10/1/2012 16487 2005 DODGE STRATUS 1928 $21,558 7398 $321 $25 $0 $0 $1000 n/a $1000 $115 $461 88 10/1/2011 10/112012 16488 2005 DODGE STRATUS 1929 $21,558 7398 $321. $25 $0 $0 $1000 n/a $1000 $115 $461 89 10/1/2011 10/1/2012 16809 2005 DODGE GRAND CARAVAN 9202 $20,512 7398 $321 $25 $0 $0 $1000 n/a $1000 $115 $461 90 10/1/2011 10/1/2012 16888 2005 FORD, 17 PASS BUS 0776 $50,600 5882 $505 $0 $0 $0 $1000 n/a $1000 $115 $620 91 10/112011 1011/2012 1997 FORD EXPLORER 1153 $23,500 7398 $321 $25 $0 $0 31000 nta $1000 S106 $452 92 10/1/2011 6/11)2012 2605 •OR6 PICKUP 4907 $29,000 01499, $236' $8 $0 $0 n/a n/a n/a $$8 $312 93 10/1/2011 8/30/2012 2005 FORD PICKUP 4908 $29,000 01499 $310 $11 $0 $0 n/a n/a n/a $89 $410 94''1011/2011 6/11/2012 2005 FORD PICKUP 4909 $29,000 01499 $236 $8 $0 $0 n/a n/a n/a $68 $312 Page 4 of 9 Automobile Schedule City of Opa-Locka, FMIT#0435 10/01/2011 - 10/01/2012 Veh# Eft Date Exp Date City# Year Make Description ID# Cost New Code Liab PIP Med Pay UM Comp Ded SP Ded Coil Ded Phy Ding Total Pram 95 10/1/2011 10/1/2012 1998 FORD CROWN VICTORIA 3562 $22,520 7398 $321 $25 $0 $0 $1000 n/a $1000 $106 $452 96 10/1/2011 10/1/2012 1998 FORD TAURUS • • 3633 $17,520 7398 $321 $25: $0 $0 $1009 n/a $1000 $95 ' $442 97 1011/2011 10/1/2012 17119 2005 FORD CROWN VICTORIA 6258 $23,893 7398 5321 $25 $0 $0 $1000 n/a $1000 $115 $461 -98 1011/2011 4/3/2012 1995 CHEVROLET VAN 9482 $17,000 01499 $171• $6 $0 $0 . ' n/a nla n/a $29' $206 99 101112011 10/1/2012 1999 DODGE VAN 0179 $16,500 01499 $340 $12 $0 $0 $1000 n/a $1000 557 5409 . _ 100 '1011/2011 6111/2012 1999 DODGE 'VAN 2172 $10,500 01499 $238 $8 $0 $0 n/a ilia n/a • $40 $284 . . r: . . ..., . .. __ 101 10/1/2011 10/1/2012 1999 DODGE VAN 0161 $16,500 01499 $340 $12 $0 $0 $'000 n/a $1000 $57 $409• 102 10/1/2011 10/1/2012 '1964 GMC` VAN ' . . 4810 z . $15,000 - ,01499 $340- $12 . $0 $0. • $1000 n/a . $1000 . $49: $401 103 10/112011 4/312012 1996 DODGE VAN 5454 $15,000 01499 $171 $6 $0 $0 n/a n/a n/a $25 $202 104 1011/2011 6/11/2.012` 1997 FORD PASSENGER CAR 1359 $21,000 7398 $222 :$17 $0 $0 n/a We ..n/a . $74. $313 105 10/1/2011 10/1/2012 2006 FORD TAURUS 5807 $20,263 7398 5321 525 $0 $0 $1000 n/a $1000 $124 3470 106 10/112011 10/112012 . 2006 FORD TAURUS. $806' $20,263 7398 $321 - $25 $0 $0. - $1000 . n/a $1000 $124. $470 107 10/112011 10/1/2012 2006 FORD TAURUS 0372 $20,263 7911 $369 $29 $0 $0 $1000 n/a $1000 $121 $519 108 101112011 5111/2012 2006 FORD TAURUS ' 0371 , $20,263 7911 • '$256 $20. . $0 $0 We n/a n/a $84 $360 109 10/112011 10/112012 2006 FORD TAURUS 0373 $20,263 7911 $369 $29 $0 $0 $1000 nla $1000 $121 $519 • 110 10/112011 101112012 2006 FORD TAURUS 5809 .$20,263 7398 $321 $25 $0 $0. $1000 n/a $1000 $124 $470 111 10/1/2011 10/1/2012 2006 FORD TAURUS 5808 $20,263 7398 $321 $25 $0 $0 $1000 nla $1000 $124 $470 . . . . _ .. 112 10/112011 10/1/2012 2006 FORD E350 XL 4723 $17,917 01499 8340 . •'512., $0 $0 $1000 n/a• $1000 $79 . $431• 113 10/1/2011 10/1/2012 2006 FORD E350 XL 4722 $17,917 01499 $340 $12 $0 $0 $1000 n/a $1000 $79 $431 . .. .. - 114 1011/2011 10/112012 2006 DODGE CHARGER'. 9803 $24,959: 7911 $369 $29 $0 $0 $1000 , n/a $1000 $121 $519 115 10/112011 10/1/2012 2006 DODGE CHARGER 9804 $24,959 7911 $369 $29 $0 $0 $1000 n/a $1000 $121 $519 116 10/1/2011 10►1/2012 2006 DODGE CHARGER 9806 824,959 ' 7911 $369 $29 $0 $0. ' $1000 n/a $1000 $121 $519 . .. . .. . . .. 117 10/1/2011 101112012 2006 DODGE CHARGER 9807 $24,959 7911 $369 $29 $0 $0 $1000 n/a $1000 $121 $519•118 101112011 10/1/2012 2006 DODGE CHARGER 9808 $24,959 7811 6369 $29 50 . 50 $1000 nla $1000 $121 $519 Page 5 of 9 Automobile Schedule - - -• • - • • City of Opa-Locka, FMIT#0435 10/01/2011 -10/01/2012 Veh# Eif Date Exp Date City# Year Make Description ID# Cost New Code Liab PIP Med Pay UM Comp Ded SP Ded Coll Ded Phy Drng Total Pram 119 1011/2011 10/1/2012 2006 DODGE CHARGER 9809 $24,959 7911 $369 $29 $0 $0 $1000 n/a $1000 $121 $519 120 1011/2011 811112072' 2006 DODGE CHARGER 9812, $24,859 ' 7911 $256 $20 $0 $0 ' n/a • nla n/a :$84, $360 121 10/1/2011 10/1/2012 2006 DODGE 4...__ _. CHARGER 98114 4 $24,9959 7911 $369 $29 $0 $0 $1000 n/a $1000 $121 $519 122 10/1/2011 10/1/2012 2006 DODGE - 9 " '• CHARGER 9788, $24,9b9 7911 $369.. $29 $0 $0 $1000 n/a $1000 $121 • $519 123 10/1/2011 10/1/2012 2006 DODGE CHARGER 9799 $24,959 7911 $369 $29 $0 $0 $1000 n/a $1000 $121 1_ 124 1011/2011 6/1112012 DODGE 2006 DOE CHARGER " ' 9802 .• $24,959 4 ' 7911 $256 " $20 $0 $0 `nia ,_ n- $84 $360 125 10/112011 10/1/2012 2006 DODGE CHARGER 9805 $24,959 7911 $369 $29 $0 $0 $1000 n/a $1000 $121 $519 `126 10/it2011 10/112012• . 2006 DODGE. H ' GHARGEt2 9811 $25,047 7911 5359 $29,. $0 $0 $10,00 nla $1000• $138 $536 127 10/112011 1011!2012 2006 DODGE CHARGER 9813 $26,047 7911 $369 $29 $0 $0 $1000 n/a $1000 $138 $536•128 10/1/2011 -10/112012:' 2006 DODGE' - CHARGER 9800 . $25,047 . . 7911 $369 . $29 40 $0 ' $1000 .nia $1000 $138 . $536 129 10/1/2011 6/11/2012 2007 HARLEY DAVIDSON MOTORCYCLE 5539 $21,000 798,6 $189 $0 $0 $0 n/a n/a n/a $51 $240 130 10/1/2011 6/11/2012 2007 HARLEY DAVIDSON MOTORCYCLE 5441 , $21,000 '7986 5189 $0 $0 $0 n/a n/a nla $51 ' $240 131 10/1/2011 1011/2012 2007 DODGE DAKOTA 6613 512,565 7398 $321 $25 $0 $0 $1000 n/a $1000 $101 $447 10/1/2012 2007 DODGE DAKOTA _ 132 101112071 ;, 6612 $12,665 ' 7398 5321 $25 $0 . $0 $1000 n/a $1000 $101 $447 133 1D/1/2011 10/1/2012 2007 DODGE DAKOTA 6614 $12,565 7396 5321 $25 $0 $0 $1000 n/a $1000 $101 $447 134 10/1/2011 10/1/2012 2007 DODGE DAKOTA 6615 $12,655 7398 $321 $25 $0 $0 $1000 n/a $1000 $101 $447 7188 ..$ 135 10/1!2011 6117/2012 2008 FORD ESCAPE XLT 7188 $16,150 7398 $222 $17 $0 $0 n/a n/a n/a $97 $336 • • 136 10/1/2011 10/112012 ' 2008 FORD -. 0 ESCAPE"XLT 7789 $16,150 ' ' : 7398 . $321 . $25 $0 $0 $1000 •' n/a $1000 • $141 $487 137 10/1/2011 101112011 2006 FORD TAURUS 2653 $21,080 7398 $0 $0 $0 $0 n/a n/a n/a $0 $0 • 138. 10/1/2011 `10/1/2011 2008:FORD TAURUS ?740. $21,080 ' 7398 $0 $0 $Q $0 n/a n/a •. nla $0 $0 139 10/1/2011 10/1/2011 2008 FORD TAURUS 2702 $21,080 7398 $0 $0 $0 $0 n/a n/a n/a $0 $0 ' 140 10/112011 1011/2012 : 2008 FORD 'F150 Pia/G.)13.' ICKUP . 4366 ;22,870 - . , .. 01499 $340 $12 $0 $0 • $1000 n/a 3... . $100 $452 141 10/1/2011 6/11/2012 2008 FORD F150 PICKUP 4418 $22,870 01499 $236 $8 $0 $0 n/a n/a n/a $69 $313 ' 142 10/1/2011 4/3/2012 1996 INTERNTIONAL 50 PASS BUS 3267 544,158 5883. $445 $0 $0 $0• n/a nla n/a $45 $490 Page 6 of 9 Automobile Schedule City of Opa-Locka, EMIT#0435 10/01/2011 -10/01/2012 Veh# Eft Date Exp Date City# Year Make Description ID 4 Cost New Code Liab PIP Med Pay UM Comp Ded SP Ded Coll Ded Phy Ding Total Prem 143 1011/2011 10/1/2012 1996 INTERNTIONAL 50 PASS BUS 3160 $44,156 5883 $882 $0 $0 $0 $1000 n/a $1000 $89 $971 144 1011/2011 10/1/2012 1996 INTERNTIONAL' '30 PASS BUS .. 3278. $44,156 ' ...• 5883 $882; $0 $0', $0 $1000 nta $1000 $59 $971 • 145 10/1/2011 10/1/2012 2008 FORD F150 PICKUP 1509 522,870 01499 $340 $12 $0 $0 $1000 n/a $1000 $100 $452 146 .10/1/2011, 6111/2012 2008 FORD GRAND MARQUIS 4482 $22,000 7398, $222 $17 $0 - $0 ' : n/a n/a n/a $108 $347 147 10/1/2011 10/1/2012 2008 FORD 16 PASS VAN 1312 $23,648 5882 5505 $0 $0 $0 $1000 n/a $1000 $84 $589 148 10/112011 10/1/2012 2008;FORD 15 PASS VAN 1311 $23,650 • 5882• $505 $0 $0 $0 $1000 1115 $1060 • $84 $589 149 10/1/2011 10/1/2012 2001 DODGE PICKUP 1582 $18,000 01499 $340 $12 $0 $0 $1000 n/a $1000 $57 5409 150 10/1/2011 4/3/2012: 2001 BLUEBIRD 26PASS BUS . 7509 $100,000`• ' ' 5883 $445 $0- $0 '' $0 n/a ri/a n/a ' •• $63 • $508 151 10/1/2011 4/3/2012 2001 BLUEBIRD 26 PASS BUS 0180 5100,000 5883 $445 $0 $0 $0 n/a n/a n/a $63 $508 152 101.1/2011 6/1112012 2007 FORD EXPEDITION 3662 $29,900•7911 $258 $20 $0 $0 n/a n/a n/a $95 $371• 153 10/1/2011 6/1112012 2009 FORD EXPEDITION 9608 $31,664 7911 $256 $20 $0 $0 n/a n/a n/a $120 $396 154 1011/2011 6/11/2012 2008 HARLEY DAVIDSON MOTORCYCLE , • 6830 $22;247 7986 $189 '$0 '$0 $0 as n/a .n/a $67 $256 155 10/112011 6/11/2012 2008 HARLEY DAVIDSON MOTORCYCLE 6790 $22,247 7986 $189 $0 $0 $0 n/a n/a n/a $67 5256 156 10,1/2011 6/11/2012. 1995 GMC - 'YUKON 2077.. $0 • • 7911 $256 $20." $0 $0 n/a n/a n/a $0 $276 . 157 10;112011 6/11/2012 1989 CADILLAC FLEETWOOD 1778 $0 7911 $256 $20 $0 $D n/a n/a n/a $0 $276 158 10;1/2011 6/11/2012 1996 FORD 8250 2004 $0 7912 $302 $12 "' $0 $0 n/a n/a n/a $0 $314 159 10/1/2011 6/11/2012 1989 CHEVROLET CAMARO 1989 $0 7911 $256 $20 $0 $0 n/a n/a rda $0 $276 160 10/1/2011 1011/2012 2005 FORD 1.150 0523 $19,610 7911 $369. $29. $0 ' $0 $1000 n/a $1000 $102 • $500 161 10/1/2011 1011/2012 2004 NISSAN MAXIMA 5885 $26,950 7911 $369 $29 $0 $0 $1000 n/a $1000 $129 $527•162 10/1/2011 10/1/2012 2001 JA GUAR S-TYPE ' • 7907 $49,355. 7911 $360 $29 - $0 - • $0 $1000 ' n/a . '$1000 $150 $548 163 10/1/2011 10/1/2012 2009 DODGE CHARGER 4712 $26,881 7911 5369 529 50 50 $1000 n/a $1000 $173 $571 • 164 10/112011 10/112012 2009 DODGE CHARGER ' 4716 $26,881 " 7911 $369' $29 $0 $0 $1000 • n/a • $1000 $173 $571 . 165 10/1/2011 1011/2012 2009 DODGE CHARGER 4717 $26,881 7911 $369 $29 $0 $0 $1000 n/a $1000 $173 $571 . 166 10/1/2011 10/1/2012 2009 DODGE • CHARGER 4719 $26,881 7911 ..$360 $29 $0 $0 $1000 . n/a $1000 $173 $571 Page 7 of 9 Automobile Schedule City of Opa-Locka, FMIT#0435 10/01/2011 - 10/01/2012 Veh# Eff Date Exp Date City# Year Make Description ID# Cost New Code Liab PIP Med Pay UM Comp Ded SP Ded Coll Ded Phy Dmg Total Prem 167 1011/2011 10/1/2012 2009 DODGE CHARGER 4713 $26,881 7911 $369 $29 $0 SO $1000 n/a $1000 $173 $571 - 168 10/•/2011 10/112012 2009 DODGE CHARGER 4714 $26,881 7911 $369 $29 $0 $0 $1000 n/a $1000 $173 $571 169 10/1/2011 10/1/2012 2009 DODGE CHARGER 4715 $26,881 7911 $369 $29 $0 $0 $1000 n/a $1000 $173 $571 170 10/1/2011 10/1/2012 2009 DODGE CHARGER 4718 $26;881 7911 $369 $29 $0 $0 $1000 n/a $1000 5173 $571 171 10/1/2011 10/1/2012 2009 FORD EXPEDITION XLT 9701 $27,428 7911 S369 $29 $0 $0 $1000 n/a $1000 $173 $571 172 10/1/2011 10/1/2012 2008 FORD EXPEDITION XLT 2207 526,881 79.11 $369 $29 $0 $0 $1000 n/a $1000 $173 $571. 173 10/1/2011 10/1/2012 2011 FORD TAURUS 4900 52.6,412 7398 $321 $25 $0 $0 $1000 n/a $1000 $202 $548 174 1011/2011 10/1/2012 2011 SOUTHWEST • TRAILER 2139 $4,300 68499 $35 $1 $0 $0 $1000 n/a $1000 $15 $51 175 10/1/2011 10/112012 1994 FORD F150 1425 $21,953 7398 5321 $25 $0 $0 $1000 n/a $1000 $106 $452 176 1011/2011 10/1/2012 2012 HARLEY DAVIDSON MOTORCYCLE 4565 $17,400 7986 5273 $21 $0 $0 n/a 1000 $1000 $102 $396 177 10/1/2011 10/1/2012 2012 HARLEY DAVIDSON MOTORCYCLE 4789 $17,400 7986 $273 $21 SO $0 n/a 1000 $1000 $102 $396 178 10/1/2011 10/1/2012 2012 HARLEY DAVIDSON MOTORCYCLE 4836 $17,409 7985 $273; $21 '$0 $0 n/a 1000 $1000 $102 $398 179 10/1/2011 10/112012 0304 2003 FORD CROWN VICTORIA 4062 $22,935 7911 $369 $29 $0 $0 $1000 n/a $1000 $103 $501 190. 10/1/2011 10/1/2012 0305 2003 FORD CROWN VICTORIA _ ,.: . . 4060 $22,935 7911 $369 $29 $0 $0 $1000 n/a $1000 $103 $501 181 10/1/2011 10/1/2012 0306 2003 FORD CROWN VICTORIA 4068 $22,935 7911 $369 $29 $0 $0 $1000 n/a $1000 $103 $501 182 10/1/2011 10/1/2012 0301 2003 FORD CROWN VICTORIA 2434 $22,935 7911 5369 $29 $0 $0 $1000 n/a $1000 $103 $501 183 10/1/2011 10/1/2012 0303 2003 FORD CROWN VICTORIA 2450 $22,935 7911 $369 $29 $0 $0 $1000 n/a $1000 $103 $501 184 10/112011 10/1/2012 0302 2003 FORD CROWN VICTORIA 2432 $22,936 7911 $369 $29 $0 $0 $1000 nla $1000 $103 $501 185 1011/2011 10/1/2012 0403 2004 FORD CROWN VICTORIA 9574 $24,575 7911 $369 $29 $0 $0 $1000 n/a $1000 $112 $510 186 10/1/2011 10/1/2012 0405 2004 FORD CROWN VICTORIA 9569 $24;675 7911 $369 $29. • 50 $0 $1000 n/a $1000 $112 $510 187 10/1/2011 10/1/2012 0404 2004 FORD CROWN VICTORIA 9562 $24,575 7911 $369 $29 $0 $0 $1000 n/a $1000 $112 $510 188 16112011 10/1%2012 0408 2004 FORD CROWN VICTORIA 1184 $24;575 7911 $369 $29 $0 $0 $1000 n/a $1000 $112 $510 189 10/1/2011 10/1/2012 0406 2004 FORD CROWN VICTORIA 1189 $24,575 7911 $369 $29 $0 $0 $1000 n/a $1000 5112 $510 190 10/1/2011 10/112012 0407 2004 FORD CROWN VICTORIA 1199 $24,575 7911 $369 $29 $0 $0 $1000 n/a $1000 $112 $510 Page 8 of 9 Automobile Schedule • City of Opa-Locka, FMIT#0435 10/01/2011 -10/01/2012 Vet# Eff Date Exp Date City# Year Make Description ID# Cost New Code Lab PIP Med Pay UM Comp Ded SP Ded Coll Ded Phy Dmg Total Prem 1 91 10/1/2011 10/1/2012 9905 1999 FORD CROWN VICTORIA 4723 $11,100 7911 $369 $29 $0 $0 $1000 n/a $1000 $84 5482 192 1011/2011 10/1/2012 2011 FORD CROWN VICTORIA- 9426 `$22,595 7911 $369 $29 $0" $0.. $1000 n/a $1000 $173 $571 1 93 10/1/2011 10/112012 2011 FORD CROWN VICTORIA 9427 $22,596 7911 $369 $29 $0 $0 $1000 n/a S1000 $173 $571 194 10/1/2011. 1011/2012` 2011 FORD CROWN VICTORIA'" 9428 $22,596 7911 $369 929 $0 ' ":.$0 $1000 ' ala 91000 $173 $571 195 10!112011 10/1/2012 2011 FORD CROWN VICTORIA 9429 $22,596 7911 $369 $29 $0 $0 $1000 n/a $1000 $173 $571 198 10/1/2011 10/1/2012 2011 FORD . CROWN VICTORIA; .' ` 9430 $22,596 7911 $369 $29 $0 $0 $1000 n/a: $1000 $173 $571 197 10/112011 10/1/2012 2011 FORD CROWN VICTORIA 9431 $22,596 7911 $369 $29 $0 $0 $1000 n/a $1000 $173 $571 198 1011/2011 10/1/2012 2011 FORD CROWN VICTORIA . 9432 $22,596' ' 7911 9369' ' $29 $0 • $0 $1000 ' • n/a $1000 $173 9571 199 10/1/2011 10/1/2012 2011 FORD TAURUS 9936 $26,412 7393 5321 $25 $0 $0 $1000 n/a $1000 $202 5548 200 10/1/2011 1011/2012 2011 FORD TAURU$ 9937 926,412 . 7398 5321 $25 90 $0 $1000 ; n/a - . $1000 $202 $548 201 10/1/2011 101112012 2011 FORD TAURUS 9939 $26,412 739E $321 $25 $0 $0 $1000 n/a $1000 $202 $548 202 1071/2011 10/1/2012 2011 FORD EXPEDITION 2601 $27,402 7398 $321 $25 $0 $0 $1000 n+a 91000 $202 $548 203 10/1/2011 1011/2012 2006 DODGE 40 9812 $26,150 7398 5321 $25 $0 $0 $1000 n/a $1000 5142 5488 Total Normal Premiums $61,134 $3,594 $0 $0 $18,345 $83,073 Normal Premium $83,073 Net Premium $83,073 Page 9 of 9 Florida Municipal Insurance Trust WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY FINAL AUDIT STATEMENT Policy No: EMIT#0435 NCCI CARRIER CODE: Policy Period: 10/01/2011 to 10/01/2012 Audit Period: 10/01/2011 to 10/01/2012 NAMED INSURED AND ADDRESS: PRODUCER: City of Opa-Locka Florida Municipal Insurance Trust 780 Fisherman Street, 4th Floo Post Office Box 530065 Opa-Locka, FL 33054 125 East Colonial Drive Orlando, FL 32853-0065 ST LOC Classification of Operations Class Exposure Rate Earned Code Premium TOTAL PAYROLL: 8,190,023 FL 1 STREET or Road MAINTENANCE OR BEAUTIFICATION 5509 247,142 8.47 20,933 & Drivers SEWER CONSTRUCTION-ALL OPERATIONS & 6306 137,891 6.59 9,087 Drivers DRIVERS, Chauffeurs and their Helpers NOC- 7380 25,956 5.76 1,495 commercial WATERWORKS OPERATION & Drivers 7520 242,798 3.91 9,493 POLICE OFFICERS & Drivers 7720 2,778,151 3.75 104,181 AUTOmobile SERVICE OR REPAIR CENTER & 8380 160,231 :3.03 4,855 Drivers SALESPERSONS, Collectors or Messengers- 8742 184,624 0.49 905 OUTSIDE CLERICAL OFFICE EMPLOYEES NOC 8810 2,991,980 0.25 7,480 Buildings - Operation: By owner, lessee or 9015 178,464 4.15 7,406 real estate management firm:all other employees PARK NOC-ALL EMPLOYEES & Drivers 9102 517,241 3.47 17,948 MUNICIPAL, TOWNSHIP, COUNTY OR STATE 9410 725,545 2.65 19,227 EMPLOYEE NOC AR Adjustment 1.020 4,060 Employer Safety Premium Credit 9765 0.020 -4,141 Drug-Free Workplace Credit 9841 0.050 -10,146 Total After Credits 192,783 Page 1 .22;21, Florida Municipal Insurance Trust WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY FINAL AUDIT STATEMENT Policy No: EMIT#0435 NCCI CARRIER CODE: Policy Period: 10/01/2011 to 10/01/2012 Audit Period: 10/01/2011 to 10/01/2012 NAMED INSURED AND ADDRESS: PRODUCER: City of Opa-Locka Florida Municipal Insurance Trust 780 Fisherman Street, 4th Floo Post Office Box 530065 Opa-Locka, FL 33054 125 East Colonial Drive Orlando, FL 32853-0065 ST LOC Classification of Operations Class Exposure Rate Earned Code Premium Experience Modification 9898 1,370 71,330 STANDARD PREMIUM 264,113 Advance Discount 0063 -25,284 Expense Constant 0900 200 Terrorism Risk Insurance Act 9740 0.0000 0 EARNED PREMIUM 239,029 Incentive Credit -25,626 Total Earned Premium 213,403.00 Previously Written Premium 188,495.00 Additional Premium 24,908.00 Total Additional including Tax/Surcharge 24,908.00 Page 2 12/2_'/:2