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SUPPLEMENTAL INSURANCE CHECKLIST <br />Q% <br />' <br />TO: CLERK OF THE COUNCIL OFFICE • <br />FROM: CONTRACT ADMINISTRATOR: <br />NAME OF CONSULTANT / PARTY: Wildan Homeland Solutions <br />AGREEMENT NUMBER (IF APPLICABLE): A-2016-253 <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 />