Laserfiche WebLink
CITY OF SANTA ANA <br />OFFICE OF THE CITY ATTORNEY <br />Certificate of Liability Insurance <br />Checklist for Consultant/Sub-recipient Policies <br />Name of Consultant/Sub-recipient: � i i FQ Lvh z &( INeA.. t I DO <br />Date Certificate of Liability Insurance Submitted: <br />T <br />Steps: (a) Obtain Copy of (Current) Contract; (b) Identify Insurance Paragraph in Contract; <br />(c) Review Insurance Requirements Stated in the Contract and Compare with the Certificate of <br />Insurance Submitted for Approval; and (d) Check -off Each Item Below During Your Review of <br />the Submitted Certificate of Insurance: <br />1. Name and Address of a Producer <br />2. Name and/or Telephone Number for <br />Producer Contact <br />3. Name and Address of Consultant/Sub <br />4. Name of the Insurance Company(ies) <br />/[ 5. Boxes Checked Identifying the Type of <br />Coverage <br />[� 6. Additional Insured Box Maybe Checked <br />and Separate Additional Insured <br />Endorsement Form Must Be Attached <br />(make sure the endorsement lists the <br />[� 7. Policy Number and Check to Verify <br />/ Insurance is Effective During Project Date <br />or Contract Term <br />,/ 8. Correct Coverage Dollar Amounts Listed <br />9. Professional Liability Insurance Listed (if <br />architect, engineer, attorney or accountant) <br />10. Project Description by Number or Location <br />(if applicable) <br />y' 11. Name of City and Address <br />j 12. Insurer's Signature Required <br />J (not the consultant's signature) <br />insurance policy #) and Verify Primary <br />Language on Acceptable Additional Insured 3. To Approve, Write "Reviewed by [sign <br />Endorsement your name]" on Every Page of Certificate <br />of Insurance and All Endorsements and <br />Write the Number of Pages (ex. 1/4 or 4/4) <br />Contact the City Attorney's Office if you have any questions — Lisa Storck x5207. <br />