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CONSULTANT INSTRUCTIONS FOR COMPLETING CITY OF REDWOOD CITY AGREEMENTS CITY OF REDWOOD CITY Instructions for completing Certificate of Insurance for Professional Services PLEASE [~END THIS LIST TO YOUR INSURANCE COMPANY OR BROKER Items checked below MUST be included on your Certificate of Insurance. ] Please make corrections to your Certificate of Insurance per items checked below. [] General Liability Insurance Coverage $1,000,000 CSL' [] Business Automobile Liability Insurance Coverage $1,000,000 CSL* [] Workers' Compensation: Statutory limit; and Employers' Liability $1,000.000 per incident* Workers' Compensation offered by the State Compensation Insurance Fund is acceptable. If a sole proprietor with no employees, Worker's Compensation and Employers' Liabilities not required, but must submit evidence of current status. Prc~-~;~-~' .......... L!cb!!!.*'/c~prcT.;ictc tc Cc~=u!?,",t'~ prcfccc!c,", e~. O_nO 000 ~; c!%.~.* [] The full name of company(s) affording coverage on the Certificate of Insurance and their A.M. Best rating. Insurance is to be placed with insurers that have a rating in A.M. Bsst's Key Rating Guide of at least A-;V and are admitted/licensed to transact the business of insurance in the State of California by the Insurance Commissioner as evidenced by listing in the official publication of the Department of Insurance of the State of California. Authorized Representative's original signature ] Project Title: AQUATIC PLANT MANAGEMENT AND ENVIRONMENTAL ENGINEERING SERVICES and Public Works Services Department. All coverage endorsements must contain the following: [] This policy will not be canceled until thirty (30) days after receipt of written notice by certified mail of cancellation by the Public Works Services Department of the City of Redwood City, California. Separate endorsements for General Liability and Automobile Liability must contain the following: [] The City of Redwood City, (or if applicable - the City of Redwood City Redevelopment Agency), its officials, employees and volunteers must be named as an additional insured with respect to liability arising out of activities performed by or on behalf of the Named Insured. ] Coverage under this policy shall be primary insurance as respects the City, its officials, employees and volunteers. ] All rights of subrogation are waived as respects all additional insureds hereunder. Please mail the Certificate of Insurance, with endorsements to: City of Redwood City, Public Works Services Department, 1400 Broadway, Redwood City, CA 94063-2594 All said insurance shall be maintained by the Consultant in full force and effect during the ENTIRE PERIOD OF PERFORMANCE under the contract. D.~;~.~ date cf The limit is $500,000 for Professional Services Agreement under $10,000. Consultant Instructions for Agreements City Attorney Approved Version 10103 2