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SUPPLEMENTAL INSURANCE CHECKLIST <br />TO: CLERK OF THE COUNCIL OFFICE <br />FROM: CONTRACT ADMINISTRATOR: J. Manriquez <br />NAME OF CONSULTANT / PARTY: Felice R. Hernandez <br />EXT.: 8123 <br />AGREEMENT NUMBER (IF APPLICABLE): N-2018-13113 <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 />NON -OWNED ❑ <br />HIRED ❑ <br />OWNED ❑ <br />GENERAL LIABILITY ® ❑ <br />PROFESSIONAL LIABILITY ® ❑ <br />WORKER'S COMPENSATION ❑ <br />REVISED: 9/19/2018 <br />