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SUPPLEMENTAL INSURANCE CHECKLIST <br />TO: CLERK OF THE COUNCIL OFFICE w� <br />FROM: CONTRACT ADMINISTRATOR: <br />NAME OF CONSULTANT I PARTY: NASBLA <br />AGREEMENT NUMBER (IF APPLICABLE): A-2016-248 <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 />❑ <br />HIRED <br />❑ <br />OWNED <br />❑ <br />GENERAL LIABILITY <br />® <br />❑ <br />PROFESSIONAL LIABILITY <br />❑ <br />WORKER'S COMPENSATION <br />® <br />❑ <br />REVISED'. 9/19/2018 <br />