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Julep - pl A, u ' 44U4&1 A44Wi -Iqw <br />CITY OF SAN LEANDRO v <br />Insurance Requirements Review Checklist Term: - - to - �s <br />Reviewer) by: ���� '`� — Date: 6 <br />Project/Service: <br />Account#:,0/0 -4o o2 --ddo . r, „?j <br />fll? <br />17. e)11 GaG <br />Approved by: ® Date: b 7 6 <br />Valuer` DGt� � <br />City contact/ext.: <br />Required <br />Coverage <br />Limits <br />Additional <br />Insured <br />11 <br />Waiver of <br />Subrogation <br />Primary <br />Insurance <br />Acceptable <br />Y s/No <br />General Liability <br />6 <br />W--*", <br />Automobile Liability <br />Workers' Comp Liability <br />N/A <br />WA <br />/1? <br />Professional Liability/EO <br />N/A <br />WA <br />WA <br />S <br />Sexual Abuset <br />Molestation <br />WA <br />WA <br />WA <br />Environmental Liability <br />WA <br />WA <br />Pollution Liability <br />t <br />WA <br />WA <br />Excess Liability <br />/y1 <br />WA <br />WA <br />WA <br />Builders Risk <br />WA <br />WA <br />WA <br />