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<br />JUN-Z?-2008 15:33 <br /> <br />COUNTY OF SAN MATEO HSA <br /> <br />6505963478 <br /> <br />P.OOl/OOS <br /> <br />CONTRACT INSURANCE APPROVAL <br /> <br />DATE: <br /> <br />6('1--7/4'1. <br />TO: ~(J Steele FAX: 363-4864 POTI: HRD 163 <br />FROM: ~ni Nath PHOl'-"'E: x5184 FAX:596-3478 P01\.'Y: HSA210 <br />Tbe following is to be completed by the department before submission to Risk ~aD:lgeme~t: <br /> <br />CONTRACTOR NAME: Redwood City Senool District <br /> <br />DOES THE CONTRACTOR TRAVEL AS APART OF THE CONTRACT SERVICES? no <br /> <br />NUMBER OF EMPLOYEES WORKING FOR CONTRACTOR: yes <br /> <br />DUTIES TO BE PERFOR..M"ED BY CONTRACTOR FOR COUNTY: Child abuse prevention and <br />intervtmtion services <br /> <br />The following will be completed by Risk Management: <br />INSURANCE COVERAGE: Amount trove Waive Modify <br />Comprehensive General Liability Sl,OOO,OOO ~ 0 <br />Motor Vehicle Liability $1,000,000 O. 0 <br />;( <br />Professional Liability $1,000,000 ~ 0 <br />Workers' Compensation (Statutory) Sl,OOO,OOO 0 0 <br />REMARKS/COMMENTS: <br /> .~ ,0jcfl <br /> Date <br /> <br /> <br />_-,_'\. 1""''''''\.1"'''''''''1 ~1\.J1^lnu <br /> <br />rl.."y..,,, 0" I n Inr <br />