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Risk Management Insurance Review

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Contractor/Vendor Name:
Contract Number:
Insurance Carried:
1. Workers' Compensation
2. Commercial General Liability
3. Automobile Liability
4. Excess/Umbrella Liability
5. Professional Liability
Workers' Compensation Waiver of Subrogation:
Additional Insured Endorsement:
Limit of General Liability Insurance:
Limit of Automobile Liability Insurance:
Limit of Excess/Umbrella Liability Insurance:
Limit of Professional Liability Insurance:
Certificate of Insurance:
1. Approved Insurers
2. Adequate Policy Expiration Date
3. Description Accurate
Expiration Date of COI:
Expiration Date of COI:
Comments/Exceptions/Recommendations:
Documents Needed for Approval:
Risk Management Determination:
Returned to:
Today's Date:
Today's Date:
Reviewed by: