Liability & Insurance

Sample Form 8: Additional Insured - Vendors

Name Of Additional Insured Person(s) Or Organization(s) (Vendor) -Not acceptable if left blank. Must show exact name of the additional insured or “as required by contract”.
Your Products -Not acceptable if left blank, unless the “by contract” language is used.

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

Additional Insured - Vendors

Sample Form

Image of sample form with field definitions and explanations.