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OFFICE OF THE CITY ATTORNEY <br />Phone: (714) 647-5201 Fax: (714) 647-6515 <br />M-29 / T13 <br />*Confidential* <br />This document is subject to the attorney-client privilege. This <br />form is for internal use only. <br />TO: <br />FROM: <br />DATE: <br />RE: INSURANCE CERTIFICATES: T In, Ao'c-A <br />? Approved as to form and returned. <br />? Need contract to verify Agreement terms. ? Need Contract to determine what other insurance is required. <br />? Please resubmit to me with additional information as requested. Please attach this form to your re-submittal. <br />? Accord certificate needs additional insured endorsement. <br />? Contract requires auto liability insurance. <br />? Needs general liability. <br />? Need proof of insurance: Workers Compensation ; Errors & Omissions <br />? Workers Compensation or Errors & Omission Certificates have expired. It must be renewed. <br />? Check policy expiration dates. ? Remind project manager insurance expires <br />? City requires cross-outs of following words in cancellation clause (bottom right corner) "endeavor to" and from <br />"but failure to ....... to end. <br />? City requires 30 days notice of cancellation rather than 10 days. <br />? City requires additional insured endorsement (see attached sample) - for general liability insurance. <br />City requires an additional insured endorsement - placing the wording on the certificate is not sufficient. <br />? The additional insured endorsement must contain a clause stating their insurance is primary and ours will not contribute in a <br />loss. <br />? The endorsement must be signed by the insurance company or broker - not the insured. <br />? Policy number or insurance company on certificate differs from that on endorsement. <br />? The certificate/additional insured endorsement needs to name the CITY - its officers, employees, agents, volunteers and <br />representatives - Not the department. <br />? Note: SPARTA certificates do not need to be approved by CAO. <br />? For Contracts with the City - NO additional insured endorsement is needed since the CITY is an insured under the Alliant <br />and Sparta program. <br />? Other comments: