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Election Update
Official results for Rockville's 2023 election.
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Risk Management Insurance Review
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This form has been modified since it was saved. Please review all fields before submitting.
Contractor/Vendor Name:
Contract Number:
Insurance Carried:
Workers' Compensation
Commercial General Liability
Automobile Liability
Excess/Umbrella Liability
Professional Liability
Workers' Compensation Waiver of Subrogation:
-- Select One --
Yes
No
Additional Insured Endorsement:
-- Select One --
Yes
No
Limit of General Liability Insurance:
Limit of Automobile Liability Insurance:
Limit of Excess/Umbrella Liability Insurance:
Limit of Professional Liability Insurance:
Certificate of Insurance:
Approved Insurers
Adequate Policy Expiration Date
Description Accurate
Expiration Date of COI:
Expiration Date of COI:
Comments/Exceptions/Recommendations:
Documents Needed for Approval:
Risk Management Determination:
-- Select One --
Approved
Declined
Pending
Returned to:
-- Select One --
Jessica Lewis
Jonathan Pierson
Patricia Ryan
Regina Washington
Thomas Ellison
Bridget Baker
Christos Bazekis
Today's Date:
Today's Date:
Reviewed by:
-- Select One --
Marcus Odorizzi
Jamie Kohler
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