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SUPPLEMENTAL INSURANCE CHECKLIST <br />�o <br />TO: CLERK OF THE COUNCIL OFFICE <br />s <br />FROM: CONTRACT ADMINISTRATOR: CMDR. MATHEW SORENSON EXT.: 8051 <br />NAME OF CONSULTANT I PARTY: Nancy K Bohl. Inc. - The Counseling Team International <br />AGREEMENT NUMBER (IF APPLICABLE): N-2018-146 <br />Please review the insurance section of the agreement to ensure all necessary certificates of insurance are <br />submitted to the Clerk's Office. Please provide ALL documents listed to fully execute the agreement and <br />avoid payment delay to the vendor. <br />Please check all boxes below that apply to your agreement. <br />BUSINESS AUTOMOBILE LIABILITY ' <br />-49N=OWPtE& 'cltIjUE C=I) ❑ <br />HIRED ❑ <br />QWNE-D 6 ❑ <br />GENERAL LIABILITY ✓ <br />❑ <br />PROFESSIONAL LIABILITY ✓I <br />❑ <br />WORKER'S COMPENSATION ✓ <br />❑ <br />REVISED: 9/19/2018 <br />