Combined Transport Inc. Contacts: Mailing Address: Physical Address: Tax ID: MC SCAC: CMBD

Size: px
Start display at page:

Download "Combined Transport Inc. Contacts: Mailing Address: Physical Address: Tax ID: MC SCAC: CMBD"

Transcription

1 Combined Transport Inc. Physical Address: Mailing Address: Tax ID: MC SCAC: CMBD Bank: Wells Fargo Bank 99 E Broadway Eugene, OR Contact: Yvonne Philibert (541) Contacts: Accounting: Marji Peterson Financial Manager (541) ext.6533 marjip@combinedtransport.com Accounts Payable (541) Sales Managers: Scott Waggoner (541) ext.6566 scottw@combinedtransport.com Michael Paradis (541) ext.6575 michaelp@combinedtransport.com Credit References: M.D. Mullins Heavy Haul PO Box 333 CRST Flatbed Inc Hemlock Avenue Fontana, CA Contact: Ruth or Al System Transport, Inc. PO Box 3456 Spokane, WA (509) Noble & Pitts PO Box Birmingham, AL (256)

2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER McGriff, Seibels & Williams of Oregon 1800 SW First Avenue, Suite 400 Portland, OR INSURED Combined Transport, Inc. Blackwell Consolidation, LLC 5656 Crater Lake Highway P.O. Box 3667 Central Point, OR INSURER F : COVERAGES CERTIFICATE NUMBER: 5WVB6M7V REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A D C B X X COMMERCIAL GENERAL LIABILITY OTHER: CLAIMS-MADE AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS UMBRELLA LIAB EXCESS LIAB X X CERTIFICATE OF LIABILITY INSURANCE OCCUR SCHEDULED AUTOS NON-OWNED AUTOS OCCUR CLAIMS-MADE DED RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below CARGO LEGAL LIABILITY Y R943-TCT-15 EX-0710R943-TCT-15 RWE (XS) RWD (CA, IL & TX) MTC INSURER A : The Travelers Indemnity Company of Connecticut INSURER B : Zurich American Insurance Company INSURER C : XL Specialty Insurance Company INSURER D : Travelers Property Casualty Company of America 06/01/ /01/ /01/ /01/ /01/ /01/ /01/ /01/2016 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) DATE (MM/DD/YYYY) 11/05/2015 CONTACT NAME: PHONE FAX (A/C, No, Ext): (A/C, No): ADDRESS: INSURER E : INSURER(S) AFFORDING COVERAGE EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) EACH OCCURRENCE AGGREGATE ,000, ,000 5,000 1,000,000 2,000,000 2,000,000 4,000,000 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- X POLICY JECT LOC X PER STATUTE OTH- ER E.L. EACH ACCIDENT 1,000,000 E.L. DISEASE - EA EMPLOYEE 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 Per Conveyance/Disaster 1,000,000 NAIC # CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Evidence of Insurance AUTHORIZED REPRESENTATIVE ACORD 25 (2014/01) Page 1 of ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD

3 ACORDTM CERTIFICATE OF LIABILITY INSURANCE PRODUCER American Trucking and Transportation Ins. Co., a Risk Retention Group 111 North Higgins Avenue, Suite 300A Missoula, Montana (406) INSURED Combined Transport, Inc. Cardmoore Trucking Ltd. Partnership P.O. Box Crater Lake Avenue Central Point, Oregon Blackwell Consolidation, LLC P.O. Box Blackwell Road Central Point, OR DATE (MM/DD/YYYY) 06/01/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURER A: American Trucking and Transportation Insurance Company Risk Retention Group INSURER B: N/A INSURER C: N/A COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurrence) CLAIMS OCCUR MADE MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE GEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG POLICY PRO- JECT LOC A AUTOMOBILE LIABILITY X ANY AUTO ATTCTI115 06/01/ /31/2016 COMBINED SINGLE LIMIT (Ea accident) 5,000,000 ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) HIRED AUTOS NON-OWNED AUTOS BODILY INJURY (Per accident) X TRAILER INTERCHANGE 50,000 LIMIT PER TRAILER PROPERTY DAMAGE (Per accident) NON-TRUCKING LIABILITY GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ANY AUTO OTHER THAN EA AUTO ONLY: ACC AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE OCCUR CLAIMS MADE AGGREGATE DEDUCTIBLE RETENTION WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETARY/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT Other DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL THIRTY (30) DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2001/08) ACORD CORPORATION 1988

4 01/01/2015

5 P.O. Box 3667 Central Point, OR (541) (800) Fax (541) CREDIT APPLICATION COMPANY NAME: Federal I.D. #: Sole Proprietor, Partnership, Or Corporation: Attention: President or Owner s Name: Mailing Address: City: State: Zip: Physical Address: City: State: Zip: Phone #: Fax #: Yrs. in Business: # of Locations: # of Employees: If Corporation, Address of Corporate Headquarters: Accounts Payable Contact: Phone Number: Fax Number: Phone Number or Extension: Special Instructions: Bank Name: Bank Address: Bank Account Number: Trade Reference: Trade Reference: Trade Reference: Trade Reference: Dispatcher s Name: Bank Contact: Phone Number: Fax Number: Phone Number: Fax Number: Phone Number: Fax Number: Phone Number: Fax Number: Phone Number: Fax Number: CREDIT AGREEMENT: upon acceptance of this application, I/We agree to the following. In accordance with the I.C.C. regulations, all invoices must be paid within fifteen (15) days of invoice date, unless alternate arrangements have been made and agreed to in writing by all parties. Any account surpassing the agreed upon terms may have their credit privileges suspended until the account is paid in full. A 2% per month finance charge may be applied to all unpaid balances, as stated on each invoice. Combined Transport, Inc. reserves the right to seek pre and post-judgment interest from the date of invoice, at a rate of 24% annually, as well as court cost and attorney fees, if litigation ensues. PLEASE SIGN TO AUTHORIZE US THE RIGHT TO ALL CREDIT INQUIRES: Signature: Date: Please Print Name: Title:

6 P.O. BOX 3667 CENTRAL POINT, OR ACCOUNTI NG DEPARTMENT (541) (800) FAX (541) **** COMBINED TRANSPORT. INC****. WIRE / ACH SET-UP INFORMATION Bank Name: Address: Wells Fargo Bank 99 E. Broadway City, State, & Zip: Eugene, OR Contact Person at Bank: Yvonne Philibert Bank Phone #: Account #: ABA #: SWIFT CODE: WFBIUS6S Please provide Combined Transport s invoice # in the remittance . Remittance AR@combinedtransport.com If you have any questions, or need any additional information, please contact Pam Hurley, at:

7

8

9

10

11 April 16, 2015 JON CARD COMBINED TRANSPORT INC PO BOX 3667 CENTRAL POINT, OR CERTIFICATE OF STANDARD CARRIER ALPHA CODE (SCAC) RENEWAL The Standard Carrier Alpha Code of COMBINED TRANSPORT INC PO BOX 3667 CENTRAL POINT, OR MC US DOT CMBD has been renewed for: This Alpha Code will apply only to the company name shown above through June 30, Approximately two months prior to expiration of this SCAC, NMFTA will provide a renewal notice which must be promptly returned together with payment to ensure its continued validity. Should the company name or address change, please notify the National Motor Freight Association, Inc. at the address below. Alpha Codes ending with the letter "U" have been reserved for the identification of freight containers. If your Alpha Code ends with the letter "U", it should be used only for this purpose. A non-u ending Alpha Code should be obtained to satisfy other requirements such as company identification for Customs, Electronic Data Interchange, freight payments, etc. If you participate in the Bureau of Customs and Border Protection (BCBP) automated programs (ACE, AMS,CAFES, FAST, PAPS), your SCAC and related company information has been sent to BCBP electronically and is updated on a nightly basis. If you have encountered a problem using your SCAC with BCBP, or a copy this letter has been requested by BCBP, only then should you forward the requested information ( preferred as a PDF or TIF attachment) to the following address: CBP SCAC Processing Bureau of Customs and Border Protection 7681 Boston Blvd., Beauregard 1st Fl Wing A Springfield, VA AMS.SCAC@DHS.GOV NOTICE: Renewal of the above listed SCAC is unrelated to participation in the National Motor Freight Classification (NMFC). Further, it does not confer membership in the National Motor Freight Traffic Association, Inc. nor allow use of the NMFC inconnection with freight rates. For participation and membership information, please call (703) North Fairfax Street Suite 600 Alexandria, VA ph: fax: web: scac@nmfta.org

12 UNITED STATES OF AMERICA DEPARTMENT OF TRANSPORTATION PIPELINE AND HAZARDOUS MATERIALS SAFETY ADMINISTRATION HAZARDOUS MATERIALS CERTIFICATE OF REGISTRATION FOR REGISTRATION YEAR(S) Registrant: COMBINED TRANSPORT, INC Attn: JON CARD PO BOX 3667 CENTRAL POINT, OR This certifies that the registrant is registered with the U.S. Department of Transportation as required by 49 CFR Part 107, Subpart G. This certificate is issued under the authority of 49 U.S.C It is unlawful to alter or falsify this document. Reg. No: XZ Issued: 06/03/2015 Expires: 06/30/2018 HM Company ID: Record Keeping Requirements for the Registration Program The following must be maintained at the principal place of business for a period of three years from the date of issuance of this Certificate of Registration: (1) A copy of the registration statement filed with PHMSA; and (2) This Certificate of Registration Each person subject to the registration requirement must furnish that person s Certificate of Registration (or a copy) and all other records and information pertaining to the information contained in the registration statement to an authorized representative or special agent of the U. S. Department of Transportation upon request. Each motor carrier (private or for-hire) and each vessel operator subject to the registration requirement must keep a copy of the current Certificate of Registration or another document bearing the registration number identified as the "U.S. DOT Hazmat Reg. No." in each truck and truck tractor or vessel (trailers and semi-trailers not included) used to transport hazardous materials subject to the registration requirement. The Certificate of Registration or document bearing the registration number must be made available, upon request, to enforcement personnel. For information, contact the Hazardous Materials Registration Manager, PHH-52, Pipeline and Hazardous Materials Safety Administration, U.S. Department of Transportation, 1200 New Jersey Avenue, SE, Washington, DC 20590, telephone (202)

Go-To Transport, Inc. 04/28/2016 2005108137 NAICS Codes: 484121, 541614 UNSPSC Codes: 78000000 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 9/8/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION

More information

SECURITY WEAVER LLC 401 W A ST STE 2200 SAN DIEGO CA 92101

SECURITY WEAVER LLC 401 W A ST STE 2200 SAN DIEGO CA 92101 PO BOX 33015 SAN ANTONIO TX 78265 SECURITY WEAVER LLC 401 W A ST STE 2200 SAN DIEGO CA 92101 CERTIFICATE.OF.LIABILITY.INSURANCE EMJ R054 4/9/2015 DATE THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION

More information

Bonding and Insurance Information

Bonding and Insurance Information Bonding and Insurance Information The Exeter Group of Companies, including and Exeter bonding and insurance coverage information: Fidelity Bond Coverage 5 Million Errors and Omissions Insurance 1 Million

More information

Navajo Mine Permit Application Package SECTION LIABILITY INSURANCE TABLE OF CONTENTS 7 LIABILITY INSURANCE... 7-1

Navajo Mine Permit Application Package SECTION LIABILITY INSURANCE TABLE OF CONTENTS 7 LIABILITY INSURANCE... 7-1 SECTION 7 LIABILITY INSURANCE TABLE OF CONTENTS SECTION SECTION TITLE PAGE NUMBER 7 LIABILITY INSURANCE... 7-1 7-i SECTION 7 LIABILITY INSURANCE LIST OF APPENDICES APPENDIX NUMBER APPENDIX TITLE 7.A Certificate

More information

EXHIBIT J CERTIFICATE OF LIABILITY INSURANCE

EXHIBIT J CERTIFICATE OF LIABILITY INSURANCE EXHIBIT J CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY

More information

JB Transport, LLC MC#558125. P.O. Box 129 Sandy Hook, MS 39478 Phone: 601-736-1151 Toll Free: 800-956-1151 Fax: 601-222-2459

JB Transport, LLC MC#558125. P.O. Box 129 Sandy Hook, MS 39478 Phone: 601-736-1151 Toll Free: 800-956-1151 Fax: 601-222-2459 JB Transport, LLC MC#558125 P.O. Box 129 Sandy Hook, MS 39478 Phone: 601-736-1151 Toll Free: 800-956-1151 Fax: 601-222-2459 Flatbed/Step Deck Dispatch dispatch@jbtransport.com Brett Stogner Ext. 104: brett@jbtransport.com

More information

Fidelity Bond And Errors & Omissions

Fidelity Bond And Errors & Omissions Fidelity Bond And Errors & Omissions Insurance Coverage Information 402 West Broadway, Suite 400, San Diego, California 92101 Office: (619) 615-4210 Facsimile: (619) 615-4205 Web site: www.exeter1031.com

More information

INSURANCE INSTRUCTIONS

INSURANCE INSTRUCTIONS INSURANCE INSTRUCTIONS The following instructions, Sample Certificate of Insurance, and Sample Endorsements are provided to assist Subcontractors in complying with the insurance requirements for Lawrence

More information

CERTIFICATE OF LIABILITY INSURANCE

CERTIFICATE OF LIABILITY INSURANCE COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: PRO- POLICY JECT LOC AUTOMOBILE LIABILITY UMBRELLA LIAB ECESS LIAB CERTIFICATE OF LIABILITY INSURANCE OCCUR CLAIMS-MADE

More information

KIWANIS CERTIFICATES OF INSURANCE

KIWANIS CERTIFICATES OF INSURANCE KIWANIS CERTIFICATES OF INSURANCE A current Certificate Packet is enclosed. Please make copies as needed so you have Certificates on hand for future events. On page 2, the Certificate of Insurance Procedures

More information

New Carrier Packet Checklist. Below is a list of the documents required by Exxact Express, Inc. to be set up as a carrier:

New Carrier Packet Checklist. Below is a list of the documents required by Exxact Express, Inc. to be set up as a carrier: New Carrier Packet Checklist Below is a list of the documents reuired by Exxact Express, Inc. to be set up as a carrier: New Carrier Information Page W-9 Liability, Cargo and Worker's Comp Certificates

More information

CERTIFICATE OF LIABILITY INSURANCE

CERTIFICATE OF LIABILITY INSURANCE INSURED CERTIFICATE OF LIABILITY INSURANCE PLANI-1 DATE (MM/DD/YYYY) INSURER(S) AFFORDING COVERAGE NAIC # Burlington Insurance Co. INSURER A : 23620 Travelers Prop Cas Co of Amer INSURER B : 25674 INSURER

More information

CERTIFICATE OF LIABILITY INSURANCE

CERTIFICATE OF LIABILITY INSURANCE PRODUCER INSURED c/o 26 Century Blvd. P.O. Box 305191 Nashville, TN 37230-5191 A GENERAL LIABILITY 79960314 12/31/2013 12/31/2014 POLICY LOC A AUTOMOBILE LIABILITY 73572697 12/31/2013 12/31/2014 ANY AUTO

More information

HORIZON LOCATIONS. HORIZON FREIGHT SYSTEM, INC Service Locations: Email MC #169607. Chaska, MN Logistics. stevez@3pointfreight.

HORIZON LOCATIONS. HORIZON FREIGHT SYSTEM, INC Service Locations: Email MC #169607. Chaska, MN Logistics. stevez@3pointfreight. HORIZON LOCATIONS To better serve you, we are always adding new locations. For terminal updates, please check our website at horizonfreightsystem.com. For any pricing, sales or operational questions, contact

More information

OYSTER POINT MARINA PLAZA 395 & 400 Oyster Point Boulevard, South San Francisco, CA 94080 T. (650) 873-1054 / F. (650) 873-3677

OYSTER POINT MARINA PLAZA 395 & 400 Oyster Point Boulevard, South San Francisco, CA 94080 T. (650) 873-1054 / F. (650) 873-3677 OYSTER POINT MARINA PLAZA 395 & 400 Oyster Point Boulevard, T. (650) 873-1054 / F. (650) 873-3677 EXHIBIT J TENANT VENDOR LIABILITY INSURANCE DOCUMENTATION REQUIREMENTS KASHIWA FUDOSAN AMERICA, INC. (herein

More information

VEHICLE INSURANCE PACKET CONTENTS:

VEHICLE INSURANCE PACKET CONTENTS: The University of Texas at Austin 2015/2016 Vehicle Insurance Packet VEHICLE INSURANCE PACKET CONTENTS: 1. Auto Accident Reporting Procedures 2. ACORD Automobile Loss Notice - To Report Auto Accidents

More information

VEHICLE INSURANCE PACKET CONTENTS:

VEHICLE INSURANCE PACKET CONTENTS: The University of Texas at Austin 2014/2015 Vehicle Insurance Packet VEHICLE INSURANCE PACKET CONTENTS: 1. Auto Accident Reporting Procedures 2. ACORD Automobile Loss Notice - To Report Auto Accidents

More information

Risk Management Department NOTICE TO CONTRACTORS / VENDORS / FACILITY USERS

Risk Management Department NOTICE TO CONTRACTORS / VENDORS / FACILITY USERS Risk Management Department NOTICE TO CONTRACTORS / VENDORS / FACILITY USERS Chapman University requires Certificates of Insurance from (1) Contractors, (2) Vendors, (3) Other Parties that provide services

More information

INSURANCE REQUIREMENTS

INSURANCE REQUIREMENTS INSURANCE REQUIREMENTS TO ENSURE COMPLIANCE WITH THE CONTRACT DOCUMENT, SUPPLIERS SHOULD FORWARD THE FOLLOWING INSURANCE CLAUSE AND SAMPLE INSURANCE FORM TO THEIR INSURANCE AGENT 1. FORMAT / TIME SUPPLIER

More information

W-9: Please fill out. The IRS requires that we keep a W-9 form on file for whomever we do business with.

W-9: Please fill out. The IRS requires that we keep a W-9 form on file for whomever we do business with. Dear Authorized Independent Contractor, Thank you for your desire to work with Gorilla Capital, Inc. and welcome! We invite you to take advantage of our website www.gorillacapital.com, as it will give

More information

P. Insurance Submittal Address: All Insurance Certificates requested shall be sent to the Clark County Purchasing and Contracts Division, Attention:

P. Insurance Submittal Address: All Insurance Certificates requested shall be sent to the Clark County Purchasing and Contracts Division, Attention: EXHIBIT B ASK PROJECT DESCRIPTION INSURANCE REQUIREMENTS TO ENSURE COMPLIANCE WITH THE CONTRACT DOCUMENT, ASK TYPE SHOULD FORWARD THE FOLLOWING INSURANCE CLAUSE AND SAMPLE INSURANCE FORM TO THEIR INSURANCE

More information

All Subcontractors. Re: Exhibit C - Certificate of Insurance Requirements (Page 1 of 9) Project: Project #:

All Subcontractors. Re: Exhibit C - Certificate of Insurance Requirements (Page 1 of 9) Project: Project #: To: All Subcontractors Re: Exhibit C - Certificate of Insurance Requirements (Page 1 of 9) Project: Project #: Documents included in this insurance requirement package: Insurance Schedule (Pages 2-3) Sample

More information

CERTIFICATE OF LIABILITY INSURANCE

CERTIFICATE OF LIABILITY INSURANCE CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY

More information

CAPTA/PUSD INSURANCE GUIDELINES

CAPTA/PUSD INSURANCE GUIDELINES CAPTA/PUSD INSURANCE GUIDELINES TABLE OF CONTENTS OVERVIEW... 3 CAPTA REQUIREMENTS... 4 HOLD HARMLESS AGREEMENT... 4 CERTIFICATE OF LIABILITY INSURANCE... 4 ENDORSEMENT... 4 CONTRACT... 4 PUSD REQUIREMENTS...

More information

EXHIBIT 1 SEMINOLE ELECTRIC COOPERATIVE, INC. (SECI) CONTRACTOR S INSURANCE REQUIREMENTS

EXHIBIT 1 SEMINOLE ELECTRIC COOPERATIVE, INC. (SECI) CONTRACTOR S INSURANCE REQUIREMENTS EXHIBIT 1 SEMINOLE ELECTRIC COOPERATIVE, INC. (SECI) CONTRACTOR S INSURANCE REQUIREMENTS Acceptable certificate(s) of insurance and policy endorsements, as specified below, showing that Contractor s insurance

More information

Insurance Requirements for the City of Oshkosh

Insurance Requirements for the City of Oshkosh Insurance Requirements for the City of Oshkosh Revised: May 12, 2014 Revised: April 14, 2014 Revised: October 23, 2013 Revised: July 16, 2012 Revised: May 25, 2012 Revised: May 9, 2012 Revised: December

More information

LAKE COUNTY SCHOOLS. January 31, 2014. Mr. James R. Owens Modular Document Solutions 12320 Crystal Commerce Loop Fort Myers, Florida 22855

LAKE COUNTY SCHOOLS. January 31, 2014. Mr. James R. Owens Modular Document Solutions 12320 Crystal Commerce Loop Fort Myers, Florida 22855 LAKE COUNTY SCHOOLS Leading our Children to Success Purchasing Department 29529 CR 561 Tavares FL 32778 (352) 253-6760 Fax: (352) 253-6761 http://lake.k12.fl.us Superintendent: School Board Members: Susan

More information

CERTIFICATE OF LIABILITY INSURANCE

CERTIFICATE OF LIABILITY INSURANCE A CC)RLY ke...------ CERTIFICATE OF LIABILITY INSURANCE OP ID: RG DATE (MM/DD/YYYY) 03/20/14 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.

More information

DJ, KJ, VJ Insurance Quote

DJ, KJ, VJ Insurance Quote DJ, KJ, VJ Insurance Quote Selected Coverage 1. General Liability Insurance 2. Property/Equipment Insurance 3. Media Insurance 4. Crime Insurance Limit Selected 1,000,000/2,000,000 0 0 0 Total Cost: How

More information

CERTIFICATE OF LIABILITY INSURANCE

CERTIFICATE OF LIABILITY INSURANCE CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY

More information

EXHIBIT A BONDS AND INSURANCE REQUIREMENTS AND FORMS

EXHIBIT A BONDS AND INSURANCE REQUIREMENTS AND FORMS EXHIBIT A BONDS AND INSURANCE REQUIREMENTS AND FORMS 1. BONDS A. The Contractor shall furnish bonds covering the faithful performance of the Contract, payment of all obligations arising thereunder and

More information

State of Idaho CERTIFICATE OF FRANCHISE AUTHORITY

State of Idaho CERTIFICATE OF FRANCHISE AUTHORITY State of Idaho I I CERTIFICATE OF FRANCHISE AUTHORITY I, BEN YSURSA, Secretary of State of the State of Idaho, hereby certify under the seal of my office that: TIME WARNER CABLE PACIFIC WEST LLC File Number

More information

CERTIFICATE OF LIABILITY INSURANCE

CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, ETEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES

More information

CERTIFICATE OF LIABILITY INSURANCE

CERTIFICATE OF LIABILITY INSURANCE Exhibit A SAMPLE CERTIFICATE OF INSURANCE TO ALL CONTRACTS/PURCHASE ORDER AGREEMENTS ACORD TM CERTIFICATE OF LIABILITY INSURANCE Date (MM/DD/YY) PRODUCER SUBCONTRACTOR S AGENT / BROKER ADDRESS CITY, STATE,

More information

INSURANCE AND SURETY INFORMATION SHEET

INSURANCE AND SURETY INFORMATION SHEET INSURANCE AND SURETY INFORMATION SHEET In order for your company to comply with the bonding and insurance requirements per your contract with the City of Elk Grove there are several things that we require.

More information

Insurance & Exhibitor Appointed Contractor Requirements

Insurance & Exhibitor Appointed Contractor Requirements Insurance & Exhibitor Appointed Contractor Requirements Insurance Requirements As mentioned in the Policies on Security page of this manual, exhibitors are urged to obtain a rider on their regular insurance

More information

Explanation of Sample UIIA Acord 22 Certificate (See Sample Acord Certificate)

Explanation of Sample UIIA Acord 22 Certificate (See Sample Acord Certificate) Explanation of Sample UIIA Acord 22 Certificate (See Sample Acord Certificate) FORM 5A 1. Full name and address of the insurance agency. 2. Insurance Agent contact information, including agent s name,

More information

Comprehensive Automobile Liability: (Including owned, non-owned, leased and Hired automobiles): $1,000,000 Per Occur.

Comprehensive Automobile Liability: (Including owned, non-owned, leased and Hired automobiles): $1,000,000 Per Occur. INSURANCE ATTACHMENT A Insurance Requirements: Workers' Compensation and Emploer's Liabilit insurance: As required b statute No exclusions for partners, proprietors or executive officers. New York Shall

More information

Attachment D. Insurance

Attachment D. Insurance Insurance Contractor/Vendor: The City and County of San Francisco would like to direct your attention to the City's insurance requirements, which have proved confusing to some bidders in the past. We have

More information

EVIDENCE OF COMMERCIAL PROPERTY INSURANCE

EVIDENCE OF COMMERCIAL PROPERTY INSURANCE EVIDENCE OF COMMERCIAL PROPERTY INSURANCE THIS IS EVIDENCE THAT INSURANCE AS IDENTIFIED BELOW HAS BEEN ISSUED, IS IN FORCE, AND CONVEYS ALL THE RIGHTS AND PRIVILEGES AFFORDED UNDER THE POLICY. Sample PRODUCER

More information

RIMS Executive Report The Risk Perspective. Recent Changes to the ACORD Form Cause and Effect

RIMS Executive Report The Risk Perspective. Recent Changes to the ACORD Form Cause and Effect RIMS Executive Report The Risk Perspective Recent Changes to the ACORD Form Cause and Effect Recent Changes to the ACORD Form Cause and Effect By Deborah A. Tauro, ARM Ann Henstrand, Chief Compliance Officer,

More information

SCDOT/CAGC Joint Committee Meeting September 25, 2013 Minutes

SCDOT/CAGC Joint Committee Meeting September 25, 2013 Minutes SCDOT/CAGC Joint Committee Meeting September 25, 2013 Minutes Attendees See attached list The meeting was called to order by Todd Steagall with introductions Old Business Contractor Status Charts were

More information

CITY OF ALTON S CDBG COMMERCIAL FAÇADE REHABILITATION PROGRAM PROGRAM DESCRIPTION

CITY OF ALTON S CDBG COMMERCIAL FAÇADE REHABILITATION PROGRAM PROGRAM DESCRIPTION CITY OF ALTON S CDBG COMMERCIAL FAÇADE REHABILITATION PROGRAM PROGRAM DESCRIPTION Summary: The Alton CDBG Commercial Rehabilitation Program provides matching grants to commercial building owners in designated

More information

Thank you for your interest in Leucadia PhotoWorks. Please follow the following steps and checklist to confirm your booking reservation.

Thank you for your interest in Leucadia PhotoWorks. Please follow the following steps and checklist to confirm your booking reservation. 374 N. Coast Highway 101, Suite F15, Encinitas, CA 92024 Thank you for your interest in Leucadia PhotoWorks. Please follow the following steps and checklist to confirm your booking reservation. Step 1:

More information

Cabling Phone Systems VoIP Solutions

Cabling Phone Systems VoIP Solutions P.O. Box 270584 Flower Mound, Texas 75011 (469) 293-9133 Phone (469) 628-4141 Mobile (817)491-8409 Fax info@lan-telcommunications.com History of Founder Steve Adams is the Owner and President of LAN-TEL

More information

ACORD' \--' DATE (MM/DD/YYYY) 02t0612014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY

More information

SUBCONTRACTOR START UP SHEET

SUBCONTRACTOR START UP SHEET SUBCONTRACTOR START UP SHEET Date: Job Name: Company Name: Contact: Phone #: Email: Please review the following and complete all forms. All documents must be completed, accurate and submitted to Encompass

More information

How To Get A Turnkey Autopsy

How To Get A Turnkey Autopsy Hidalgo County Purchasing Department 2812 S. Business Highway 281 New Administration Building Edinburg, Texas 78539 (956) 318-2626/ Fax: (956) 318-2629 October 20, 2015 Valley Forensics, PLLC Attn: Norma

More information

Crystal River Unit 3 License Transfer Notification of Transfer Date

Crystal River Unit 3 License Transfer Notification of Transfer Date Crystal River Nuclear Plant 15760 W. Power Line Street Crystal River, FL 34428 Docket 50-302 Operating License No. DPR-72 10 CFR 50.90 October 05, 2015 3F1015-01 U.S. Nuclear Regulatory Commission Attn:

More information

CERTIFICATE OF LIABILITY INSURANCE

CERTIFICATE OF LIABILITY INSURANCE UMBRELLA LIAB EXCESS LIAB CERTIFICATE OF LIABILITY INSURANCE OCCUR CLAIMS-MADE EACH OCCURRENCE AGGREGATE WC STATU- TORY LIMITS E.L. EACH ACCIDENT OTH- ER E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY

More information

April 21, 2015. 2015/16 Annual Budget / Reserve Study & Annual Disclosures. Dear Friars Village Member,

April 21, 2015. 2015/16 Annual Budget / Reserve Study & Annual Disclosures. Dear Friars Village Member, 1190 Camino Copete, San Diego, CA 92111 (858) 277 5132 / (858) 277-5135 Kathy@ark-management.com April 21, 2015 RE: 2015/16 Annual Budget / Reserve Study & Annual Disclosures Dear Friars Village Member,

More information

M MARSH &400. r4 MARSH & McLENNAN. U.S. Nuclear Regulatory Commission ATTN: Document Control Desk Washington, DC 20555-0001.

M MARSH &400. r4 MARSH & McLENNAN. U.S. Nuclear Regulatory Commission ATTN: Document Control Desk Washington, DC 20555-0001. Sarah Baldys M MARSH Marsh USA Inc. Three Logan Square 1717 Arch Street, Suite 1100 Philadelphia, PA 19103 +1 215 246 1023 Sarah.Baldys@marsh.com www.marsh.com U.S. Nuclear Regulatory Commission ATTN:

More information

SHORENSTEIN REALTY SERVICES, L.P VENDOR INSURANCE REQUIREMENTS CATEGORY D VENDORS

SHORENSTEIN REALTY SERVICES, L.P VENDOR INSURANCE REQUIREMENTS CATEGORY D VENDORS NAME AND ADDRESS OF AGENCY: NAME AND ADDRESS OF INSURED: Certificate of Insurance COMPANIES AFFORDING COVERAGES INSURANCE COMPANY S DESIGNATED MUST HAVE A MINIMUM OF A- VIII AM BEST RATING COMPANY A COMPANY

More information

POLICY _EFFECTIVE mammy) ANY AUTO OTHER TI IAN EA ADD 6. AUTO ONLY AGG a WES& / UMBRELLA LIABILITY EACH OCCURRENCE $ _

POLICY _EFFECTIVE mammy) ANY AUTO OTHER TI IAN EA ADD 6. AUTO ONLY AGG a WES& / UMBRELLA LIABILITY EACH OCCURRENCE $ _ 0 1988-2009 ACORD CORPORATION. All rights roservo -1110 ACORD name and logo are romstorod marks of ACORD priabucer E. LOGANS INSURANCE SERVICES 642 3rd Avenuo Suite 13 Chula Vista CA 91910 INSURED Fourth

More information

FULTONCOUNTY GOVERNMENT

FULTONCOUNTY GOVERNMENT FULTONCOUNTY GOVERNMENT LIBRARY CAPITAL IMPROVEMENT PROGRAM Wolf Creek Branch Library Hogan Construction GENERAL LIABILITY WRAP-UP MANUAL Version 2 November 20, 2012 Resurgens Risk Management (RRM)/ Willis

More information

Dear Carrier Partner:

Dear Carrier Partner: Dear Carrier Partner: We would like to thank you for your interest in becoming a valuable carrier partner with JAM Logistics,LLC. As a leading third-party logistics company, we provide quality transportation

More information

ADDENDUM A1. Subcontractor Insurance Requirements

ADDENDUM A1. Subcontractor Insurance Requirements ADDENDUM A1 Subcontractor Insurance Requirements Certificates and endorsements must be received and approved prior to the start of any work. No payments will be released until all insurance documents are

More information

Instructions for Completing the ACORD Certificate of Liability Insurance (Form ACORD 25 [Versions: 2009/09 & 2010/05])

Instructions for Completing the ACORD Certificate of Liability Insurance (Form ACORD 25 [Versions: 2009/09 & 2010/05]) 1. DATE (MM/DD/YYYY) this is the date the Certificate is generated; 2. PRODUCER insert the complete name and address of the insurance agency or broker issuing this Certificate; in the adjacent cell (located

More information

Instructions for Completing the ACORD Certificate of Liability Insurance (Form ACORD 25 [Version: 2010/05])

Instructions for Completing the ACORD Certificate of Liability Insurance (Form ACORD 25 [Version: 2010/05]) 1. DATE (MM/DD/YYYY) this is the date the Certificate is generated; 2. PRODUCER insert the complete name and address of the insurance agency or broker issuing this Certificate; in the adjacent cell (located

More information

INDEPENDENT CONTRACTOR- PROFESSIONAL SERVICES AGREEMENT. Description of Services. Responsibilities of the Parties

INDEPENDENT CONTRACTOR- PROFESSIONAL SERVICES AGREEMENT. Description of Services. Responsibilities of the Parties INDEPENDENT CONTRACTOR PROFESSIONAL SERVICES AGREEMENT THIS AGREEMENT ("Agreement") is effective as of this 1]_ day of MA\l, 20 15_, by and between the Parks and Leisure Services Department of Beaufo~

More information

December 1, 2015. Dear Valued Brannan Companies Subcontractor,

December 1, 2015. Dear Valued Brannan Companies Subcontractor, December 1, 2015 Dear Valued Brannan Companies Subcontractor, As another construction season winds down, the time has come to submit your annual Statement of Qualifications renewal. Please complete the

More information

CERTIFICATE OF INSURANCE TO CITY OF NEWARK CALIFORNIA ( the City ) A Municipal Corporation

CERTIFICATE OF INSURANCE TO CITY OF NEWARK CALIFORNIA ( the City ) A Municipal Corporation CERTIFICATE OF INSURANCE TO CALIFORNIA ( the City ) A Municipal Corporation Page 1 of 2 Only this Certificate of Insurance form will be accepted This certifies to the City of Newark that the following

More information

Bell Partners Industry Risk Level Report

Bell Partners Industry Risk Level Report Bell Partners Industry Risk Level Report Industry Risk Level A/C Equipment & Systems Contractors, Installation, or Repair Access/Badge/Panel Control Systems Adjusters Air Duct Cleaning Air Purification

More information

PLEASE FAX THIS PACKET BACK TO 903-831-8973 OR EMAIL TO GROYAL@TSDLOGISTICS.COM

PLEASE FAX THIS PACKET BACK TO 903-831-8973 OR EMAIL TO GROYAL@TSDLOGISTICS.COM TSD Logistics, Inc. tsdlogistics.com 800-426-7110 Dear Carrier Applicant: Thank you for your interest in becoming an approved carrier for TSD Logistics. The following items are needed in order for your

More information

EXHIBIT C CONSULTANT INSURANCE REQUIREMENTS SACRAMENTO AREA FLOOD CONTROL AGENCY

EXHIBIT C CONSULTANT INSURANCE REQUIREMENTS SACRAMENTO AREA FLOOD CONTROL AGENCY EXHIBIT C CONSULTANT INSURANCE REQUIREMENTS SACRAMENTO AREA FLOOD CONTROL AGENCY Revised: February 23, 2008 EXHIBIT C INSURANCE REQUIREMENTS Without limiting Consultant s indemnification, Consultant shall

More information

HAMPTON LUMBER SALES COMPANY

HAMPTON LUMBER SALES COMPANY 9600 SW Barnes Road Suite 200-6666 www.hamptonaffiliates.com To: ATTN: # of pages sent: 5 DATE: We want to thank you for your interest in being added to our carrier base, a group of carriers that are committed

More information

Submitting Insurance for UIIA Participants

Submitting Insurance for UIIA Participants Submitting Insurance for UIIA Participants Certificate of Insurance Form Requirement As of August 1, 2012 agents that submit paper certificates to the UIIA via e-mail, fax or mail are required to utilize

More information

EXHIBIT "A" INSURANCE REQUIREMENTS FOR RIGHT OF ENTRY AGREEMENTS

EXHIBIT A INSURANCE REQUIREMENTS FOR RIGHT OF ENTRY AGREEMENTS EXHIBIT "A" INSURANCE REQUIREMENTS FOR RIGHT OF ENTRY AGREEMENTS Contractor shall procure and maintain for the duration of the contract insurance against claims for injuries to persons or damages to Property,

More information

CERTIFICATE OF LIABILITY INSURANCE

CERTIFICATE OF LIABILITY INSURANCE MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG EACH RENCE AGGREGATE DED RETENTION E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT DATE

More information

How To Become A Vendor In Pennsylvania

How To Become A Vendor In Pennsylvania ENROLLMENT INSTRUCTIONS When you become a Your Local Leasing Company compliant vendor you are approved to offer your services to all properties managed by Your Local Leasing Company (YLLCO) anywhere in

More information

Listed are items that are required to be completed, signed and returned to Greiner Construction Inc. Please initial check off list.

Listed are items that are required to be completed, signed and returned to Greiner Construction Inc. Please initial check off list. Listed are items that are required to be completed, signed and returned to Greiner Construction Inc. Please initial check off list. - Intro Letter Page 2 - Contractor Score Page 3 - Discount Page 9 - Insurance

More information

CITY OF ORANGE FILMING PERMIT APPLICATION INSTRUCTIONS

CITY OF ORANGE FILMING PERMIT APPLICATION INSTRUCTIONS FILMING PERMIT APPLICATION INSTRUCTIONS THE REQUIRES 10 WORKING DAYS TO PROCESS AN APPLICATION REQUEST. INCOMPLETE PERMITS WILL NOT BE ACCEPTED. NO PERMITS WILL BE APPROVED IF CONDITIONS FOR APPROVAL ARE

More information

MLS TERMS & CONDITIONS

MLS TERMS & CONDITIONS MLS TERMS & CONDITIONS MLS Terms and Conditions: -- as reflected in our Credit Application -- 1. Credit Account: Payment due 21 days from date of invoice. MLS can charge interest on past due items (1.5%

More information

Contract Review: Key Terms That May Put Your Company At Risk

Contract Review: Key Terms That May Put Your Company At Risk Contract Review: Key Terms That May Put Your Company At Risk Grady Dotson, CPCU, Vice-President of CSDZ, Utah Will Kieffer, AFSB, Surety Account Executive, CSDZ, Utah Surety Bond Review Three Party Agreement:

More information

COMMERCIAL SOLICITATION FEE $45.00 PER APPLICATION

COMMERCIAL SOLICITATION FEE $45.00 PER APPLICATION Dear Solicitor: Attached you will find an Application for Solicitation within the Village of Lisle, along with a copy of the Village Code pertaining to solicitation. Please read this carefully to familiarize

More information

Certificates. Insurance

Certificates. Insurance Best Practices for Certificates of Insurance January 2007 A publication of Independent Insurance Agents of Texas Best Practices for Certificates of Insurance January 2007 A publication of Independent Insurance

More information

Certificates. Insurance

Certificates. Insurance Best Practices for Certificates of Insurance JANUARY 2012 REVISED APRIL 2013 A publication of Independent Insurance Agents of Texas 2012, 2013 P.O. Box 684487 Austin, Texas 78768 800.880.7428 fax 512.469.9512

More information

GENERAL INSTRUCTIONS AND REQUIREMENTS

GENERAL INSTRUCTIONS AND REQUIREMENTS CHICAGO TRANSIT AUTHORITY INSURANCE AND BOND REQUIREMENTS [Short Form rev. 12/04/02] REQUISITION NUMBER: SPECIFICATION NUMBER CTA: PART I. GENERAL INSTRUCTIONS AND REQUIREMENTS A. WAYS TO COMPLY WITH CTA

More information

CITY of DALY CITY INSURANCE REQUIREMENTS

CITY of DALY CITY INSURANCE REQUIREMENTS CITY of DALY CITY INSURANCE REQUIREMENTS IMPORTANT NOTE Contractors/Homeowners shall not perform any work, or allow any work to be performed, on behalf of the City or in the City right of way, until the

More information

W.E. O NEIL CONSTRUCTION CO.

W.E. O NEIL CONSTRUCTION CO. W.E. O NEIL CONSTRUCTION CO. INSURANCE REQUIREMENTS Project Name Project Address Subcontractor SHALL NOT COMMENCE WORK at the site until it has obtained and provided all insurance required by the Contract

More information

Canal Truck Insurance Application

Canal Truck Insurance Application Insurance Indemnity Sections 1 through 6 must be completed for a quote indication. Sections 7 through 9 must be completed in order to bind. 1. General Information Applicant Legal Name Company Name (DBA)

More information

CLC INSURANCE REQUIREMENTS

CLC INSURANCE REQUIREMENTS CLC INSURANCE REQUIREMENTS OVERVIEW All CLC Licensees are required to obtain a minimum of $1 million in general insurance, including product liability and other coverage. Insurance is required to help

More information

EXHIBIT D INSURANCE REQUIREMENTS

EXHIBIT D INSURANCE REQUIREMENTS A. INSURANCE Before performing any contract work, Contractor shall procure and maintain, during the life of the contract, unless otherwise specified, insurance listed below. The policies of insurance shall

More information

APPENDIX B INSURANCE & BONDING REQUIREMENTS FC-5801

APPENDIX B INSURANCE & BONDING REQUIREMENTS FC-5801 APPENDIX B INSURANCE & BONDING REQUIREMENTS ARCHITECTURAL AND ENGINEERING DESIGN SERVICES AT HARTSFIELD- JACKSON ATLANTA A. Preamble The following requirements apply to all work under the agreement. Compliance

More information

GENERAL INSTRUCTIONS AND REQUIREMENTS

GENERAL INSTRUCTIONS AND REQUIREMENTS CHICAGO TRANSIT AUTHORITY INSURANCE AND BOND REQUIREMENTS [FOR CONSTRUCTION RELATED CONTRACTS rev. 12/04/02] REQUISITION NUMBER: SPECIFICATION NUMBER CTA: PART I. GENERAL INSTRUCTIONS AND REQUIREMENTS

More information

Extralegal Truck Permit Insurance Requirements

Extralegal Truck Permit Insurance Requirements Extralegal Truck Permit Insurance Before applying for an Extralegal Truck Permit, insurance for the permittee must be on file with SFMTA s Extralegal Truck Permit department. Applicants must submit both

More information

How To Write A Certificate Of Insurance For A Car With A Safety Insurance Policy

How To Write A Certificate Of Insurance For A Car With A Safety Insurance Policy 1. DATE (MM/DD/YYYY) this is the date the Certificate is generated; 2. PRODUCER insert the complete name and address of the insurance agency or broker issuing this Certificate; Contact person s office

More information

CHECKLIST FOR INSURANCE REVIEWS

CHECKLIST FOR INSURANCE REVIEWS CHECKLIST FOR INSURANCE REVIEWS FOR DIRECT PURCHASE ORDERS FOR PROFESSIONAL SERVICES CONSULTANTS 1. Determine the applicable insurance requirements as set forth in Exhibit A. If the P.O. involves a Special

More information

domicile, including but not limited to Personal Injury Protection (PIP) and Personal Property insurance (PPI), must be carried.

domicile, including but not limited to Personal Injury Protection (PIP) and Personal Property insurance (PPI), must be carried. Independent Contractor Insurance Requirements Sample provided by Paul Hanson Partners Specialty Insurance Solutions This document should be reviewed with your broker and attorney and modifications for

More information

TRANSPORT WORLDWIDE, LLC

TRANSPORT WORLDWIDE, LLC The following information is needed in order for us to set your company up as an approved carrier for TRANSPORT WORLDWIDE, LLC. Please return to: TRANSPORT WORLDWIDE, LLC 307 Oates Road Suite H Mooresville,

More information

Douglas County Emergency Management Disaster Recovery Plan

Douglas County Emergency Management Disaster Recovery Plan Crisis Preparation and Recovery "Helping People and Organizations Survive" CivT- /t'-65q- Douglas County Emergency Management Disaster Recovery Plan PROPOSAL January 2, 2014 Purpose Statement The purpose

More information

THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS

THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS INSURER POLICY No. ENDORSEMENT NO: ISO FORM CG 20 10 11 85 (MODIFIED) COMMERCIAL GENERAL LIAIBILITY THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY ADDITIONAL INSURED - OWNERS, LESSEES OR

More information

City of Mount Shasta, California 305 N. Mt. Shasta Blvd. Mt. Shasta, CA. 96067 (530) 926-7510

City of Mount Shasta, California 305 N. Mt. Shasta Blvd. Mt. Shasta, CA. 96067 (530) 926-7510 City of Mount Shasta, California 305 N. Mt. Shasta Blvd. Mt. Shasta, CA. 96067 (530) 926-7510 OUTDOOR MERCHANDISE DISPLAY APPLICATION INSTRUCTIONS If your display is on private property, you will only

More information

CONTRACT INSURANCE REQUIREMENTS

CONTRACT INSURANCE REQUIREMENTS CONTRACT INSURANCE REQUIREMENTS Dakota County requires that each Contractor with whom the County negotiates a contract, meet standard insurance requirements. Please review these documents to acquaint yourself

More information

DABC RETAIL APPLICATION CHECKLIST

DABC RETAIL APPLICATION CHECKLIST Utah Department of Alcoholic Beverage Control P.O. Box 30408 Salt Lake City, UT 84130 DABC RETAIL APPLICATION CHECKLIST Website: www.abc.utah.gov Phone 801-977-6800 Fax 801-977-6889 The items below must

More information

McM CORPORATION COMPANIES

McM CORPORATION COMPANIES McM CORPORATION COMPANIES Commonwealth Underwriters Ltd Occidental Fire & Casualty Co. of North Carolina P O Box 5441 Wilshire Insurance Co. Richmond, VA 23220 FAX 804-359-4568 www.commund.com APPLICATION

More information

INSURANCE DEPARTMENT ALL COMPANIES LICENSED TO WRITE PROPERTY AND CASUALTY INSURANCE

INSURANCE DEPARTMENT ALL COMPANIES LICENSED TO WRITE PROPERTY AND CASUALTY INSURANCE STATE OF CONNECTICUT INSURANCE DEPARTMENT Bulletin PC-42-09 August 7,2009 TO: RE: ALL COMPANIES LICENSED TO WRITE PROPERTY AND CASUALTY INSURANCE CANCELLATION AND NONRENEWAL OF PERSONAL AND COMMERCIAL

More information

If you have any questions, please call 1-877-LOGISTX (564-4789).

If you have any questions, please call 1-877-LOGISTX (564-4789). Paramount Transportation Logistics Services, L.L.C. (PTLS) welcomes your interest in becoming an approved carrier for us. We are confident that you will find PTLS an easy company to do business with. The

More information

Third-Party Contract Insurance Guidelines

Third-Party Contract Insurance Guidelines Third-Party Contract Insurance Guidelines To: Re: Multi-Line Program Members Third-Party Contract Insurance Guidelines This edition of the Third-Party Contract Insurance Guidelines is an informational

More information