Resolution 79-15986 RESOLUTION NO. 79-15986
A RESOLUTION APPROVING AN AGREEMENT
WITH RISK MANAGEMENT SERVICES , INC.
WHEREAS, for the reasons more particular set forth
in Commission Memorandum No. 7623 the City Commission of the
City of Miami Beach deems it in the City' s best interest to
enter into an agreement with Risk Management Services, Inc. ;
and
WHEREAS, the City Manager has recommended that the
City enter into said agreement; and
WHEREAS, an appropriate agreement has been prepared
which has been approved by the City Attorney as to form and
legal sufficiency;
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION
OF THE CITY OF MIAMI BEACH, FLORIDA, that the Mayor and City
Clerk be and they are hereby authorized and directed to enter
into said agreement for and on behalf of the City of Miami Beach.
PASSED and ADOPTED this 1st day of August ,
1979.
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Mayor`
Attest:
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City Clerk
OFFICE OF THE CITY ATTORNEY-1700 CONVENTION CENTER DRIVE-MIAMI BEACH,FLORIDA 33139
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APPLICATION TO
FLORIDA DEPARTMENT OF COMMERCE
FOR MEMBERSHIP IN THE
• FLORIDA MUNICIPAL SELF-INSURER'S FUND
NAME: City of Miami Beach
0 Corporation 1$ Other
ADDRESS: _ 1700 Convention Center Drive, Miami Beach, Florida 33139
NATURE OF BUSINESS: Municipality
LIST OFFICIALS OR CORPORATE OFFICERS:
I. Name: Dr. Leonard Haber _ III. Name:
Title: Mayor _ Title:
II. Name: Gavin W. O'Brien IV. Name:
Title: City Manager Title:
INSURANCE COVERAGE IS NOW CARRIED BY: Se 1 f– Insured
I (we) hereby formally apply for continuing membership for Workmen's Compensation Self-Insurance coverage in the above-
named fund, to be effective 12:01 a.m., ,19 . , and, if accepted by its duly authorized representative, do
hereby constitute and appoint the Florida League of Cities, Inc., to act as Administrator(s) of the Fund as our agent(s)-in-fact in all
matters relating to the Workmen's Compensation Law and/or Employer's Liability Act.
I(we)further agree as follows:
(a) To accept and be bound by the provisions of the Florida Workmen's Compensation Act;
(b) That, by this reference, the terms and provisions of the Indemnity Agreement and/or Amendments thereto filed or which may
hereafter be filed with the Florida Department of Commerce are hereby adopted,approved,ratified and confirmed by us;and
further, I (we) agree to assume all of the obligations set forth therein, and in the event I (we) will pay any premium the date
the same shall become due, I (we) will pay all cost of the collection thereof, including reasonable attorney's fee and the
maximum rate of interest allowed by law on any past due premiums;
(c) To abide by the rules and regulations of the Trustees of the Fund and to conform to the terms of the agreements they may
enter into with any authorized service company as long as we remain a member of the Fund;
(d) That, in the event of any changes in corporate or business structure, or in legal entity,or if any locations are to be added to or
deleted from this coverage,I(we)agree to notify Florida Municipal Self-Insurer's Fund immediately;
(e) That should I (we) desire to cancel our.coverage, I (we) will give written notice at least 30 days prior to cancellation,and that
the Fund will give written notice 30 days prior to cancellation should they desire to cancel our coverage;
(0 That coverage under this membership shall be for Florida operations only;
(g) That the Wage Declaration Schedule(Form No.—___ )and/or Renewal Certificates,when completed and returned
to us by Florida Municipal Self-Insurer's Fund,become a part of this agreement.
WITNESSES TO SIGNATURE:
1 ^ City of Miami Beach 5.
Name of Applicant Name
2.)( 7.
Officials or Corporate Officer Address
9. CORPORATE
' SEAL •
3. — 6.
City/Town Clerk Name
4. Date: __ —_____ 8.
•
Address
(Signature may be notarized in place of witnesses)
FLORIDA LEAGUE, OF CITIES, INC. AND IS HEREBY APPROVED FOR MEMBERSHIP IN THIS FUND, AND
• COVERAGE IS EFFECTIVE THE DAY OF , 19
•
SIGNEDTI-LIS DAY OF , 19
BY:
Fund Administratur/Trustee
DATE 8~/— /9
ORIGINAL
RESOLUTION NO. 79-15986
Approving an agreement with Risk Management
Services, Inc.)