Laserfiche WebLink
SUPPLEMENTAL INSURANCE CHECKLIST <br />TO: CLERK OF THE COUNCIL OFFICE31 <br />r <br />FROM: CONTRACT ADMINISTRATOR: cm�(. Cra- t EXT.: 30 <br />NAME OF CONSULTANT/ PARTY: Ca I&or6iA 47:�fmslc, PhlebotDm <br />AGREEMENT NUMBER (IF APPLICABLE): A-2.0 14-337 <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 0 ❑ <br />0 <br />OWNED ❑ <br />GENERAL LIABILITY ❑ <br />PROFESSIONAL LIABILITY ❑ <br />WORKER'S COMPENSATION[] ❑ <br />REVISED: 9/19/2018 <br />