Owner Contractors Protective $ _________ Other $ _________ a) Each Insurance policy required by this agreement, excepting policies for compensation and worker’s professional liability, will City of Chicago is an additional insured as respects operations and read: “The activities of, or on behalf of the named insured, performed under contract with or permit from the City of Chicago.” b) The General, Automobile and Excess/Umbrella Liability Policies described provide for severability of Interest (cross liability) applicable to the named insured and the City. c) Workers Compensation and Property Insurers shall waive all rights of subrogation against the City of Chicago. d) The receipt of this certificate by the City does not constitute agreement by the City that the insurance requirements in the contract have been fully met, or that the insurance policies indicated by this certificate are in compliance with all contract requirements. Name and Address of Certificate Holder and Recipient of Notice Certificate Holder/Additional Insured Signature of Authorized Rep.: _____________________________________________ City of Chicago Agency/Company: Department of Procurement Services ______________________________________________________ 121 N. LaSalle St., #806 Address: Chicago, IL 60602 ___ Telephone: ___________________________
Owner Contractors Protective $ _________ Other $ _________ a) Each Insurance policy required by this agreement, excepting policies for worker’s compensation and professional liability, will read: “The City of Chicago is an additional insured as respects operations and activities of, or on behalf of the named insured, performed under contract with or permit from the City of Chicago.” b) The General, Automobile and Excess/Umbrella Liability Policies described provide for severability of Interest (cross liability) applicable to the named insured and the City. c) Workers Compensation and Property Insurers shall waive all rights of subrogation against the City of Chicago. d) The receipt of this certificate by the City does not constitute agreement by the City that the insurance requirements in the contract have been fully met, or that the insurance policies indicated by this certificate are in compliance with all contract requirements. Name and Address of Certificate Holder and Recipient of Notice Certificate Holder/Additional Insured City of Chicago Department of Procurement Services 121 N. LaSalle St., #806 Chicago, IL 60602 Signature of Authorized Rep.: _____________________________________________ Agency/Company: ______________________________________________________ Address: Telephone: ___________________________ ___