Liability & Insurance

Sample Form 15: Designated Insured For Covered Autos Liability Coverage

Designated Insured for Covered Autos Liability Coverage -Either the Designated Insured Endorsement or a copy of the Auto Policy Definition of "Who is an Insured" is acceptable evidence.
Schedule: Name of Person(s) or Organization(s) -The name of the additional insured should be here
Who is An Insured -When we hire a contractor, we could be liable for the contractor's actions. This definition of "insured" gives us protection on the contractor's auto policy. A copy of this is acceptable evidence of insurance.

Contact Information

Jamie Bloom, Insurance Manager

Katie MacKay, Liability Manager

Risk Management Division

Human Resources Department

Business Hours
Monday – Friday
8:00 AM – 5:00 PM
Contact us by Phone
575 Administration Drive
Room 116 B
Santa Rosa, CA 95403
38.465237, -122.725363

Sample Form

Designated Insured For Covered Autos

Sample Form

Image of sample form with field definitions and explanations.