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INSURANCE VERIFICATION FORM CITY OF REDWOOD CITY It is hereby understood and agreed that the following insurance requirements are applicable to this project and that thc applicable policies and/or endorsements contain the following coverage. ~ ~/~Additional Insured for G~neral Liability and Auto Liability Coverage Th~ City of Kedwood CitY, its Council commissions, co~i~¢es, boards, officers, employee~, and agents as additional imureds as respects tO work dot~e by Named In~ured. Primary Coverage v~Pnmaxy Coverage, General Liability Primary Coverage, Auto Liability With respect to claims arising out of the operations of the Named Insured, such insurance as afforded by this policy is prnmry and ~s not additional to or contributing with any other insurance carried by or for the b~meIit of the above Additional Insureds, Cross Liability/Severabiltty of Interest ~_~crOSS Liability, General Liability ross Liability, Auto Liability Thc naraing of more than one person, firm or corporation as insured under this policy shall not, for that reason alone, extnguish any rights of the insured against another, but this endorsement, and the naming of multiple insureds, shall not increase the total liability of the Company under this policy. Notice of Cancellation for General Liability and Auto Liability It is understood and agreed that in the event of cancellation of the Policy for any reason, including non-payment of premium, 30 days written notice will be sent to the following holder by mail: City of Redwood City P.O. Box 391 Redwood City~ CA 94064 ARm Engineering and Construction (650) 780-7380 - Phone (650) 780-7309 - Fax PLEASE FILL tN TIlE SPACES BELOW AND KETURN WITH A CERTIFICATE OF INSURANCE TO THE ADDRESS LISTED ABOVE, General Liability Auto Liability Policy No. CAR784574 CAAB51207 Effective Date: 08-01-01 08-01-01 Explrallon Date 08-01-02 08-01-02 Name of Insurance Carrler/Co~m~ercial Union* com~ ercial Union* AnthorizedRepresentatlve c"-~'v~'~--"--'~--"~-~ ignatnre) --// (Signature) *This form does not modify the ¢onlraet/agreement. *Golden Eagle Insurance