City of Cedar Rapids

PROJECT Liability Limits form

Project Name: Prime Contractor:
Contract Number:
City Contract Manager/Project Manager: Cindy Potter (ext 5846)
Agent or Contractor Contact (include phone):
Project Start Date: Contract Doc Approval
Project Projected End Date:
Is this Certificate New or a Renewal: NEW
Contract $ amount for bonds: $
Additional Comments:

Attach a copy of the Scope of Work and Insurance Addendum if Available

Yes or No

YES	3 Endorsements Required of Contractor, Project Designer and Project Manager

NO	Iowa Jobs Grant funds are paying all or part of cost

Limit	Type of Liability Insurance

$1,000,000	General Liability Occurrence

$1,000,000	Personal & Advertising Injury

$2,000,000	General Liability Aggregate

$2,000,000	Products & Completed Operations Aggregate

$1,000,000	Auto Liability each accident

$5,000,000	Umbrella/Excess Occurrence

Statutory	Workers Compensation and Employer Liability

$	Asbestos Abatement

$	Pollution Occurrence

$	Railroad Protective Occurrence

$	Railroad Protective Aggregate

$	Builders Risk Property Insurance

Send completed form to Risk Manager with each Certificate and Attachments via email to j.lynch@cedar-rapids.org