Liability & Insurance

Sample Form 16: Additional Insured – Not Engaged By The Named Insured

Name of Additional Insured Engineers, Architects or Surveyors Not Engaged By The Named Insured - Not acceptable if left blank. Must show exact name of the design professional or "as required by contract".
Section II - Who Is An Insured -When we contract with an outside design professional, the agreement often specifies that our contractor's policy grant additional insured status to the design professional.

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
Address
575 Administration Drive
Room 116 B
Santa Rosa, CA 95403
38.465237, -122.725363

Sample Form

Additional Insured - Not Engaged By The Named Insured

Sample Form

Image of sample form with field definitions and explanations.