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request for proposals - Sonoma County Transportation Authority

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Exhibit D<br />

Insurance Questionnaire<br />

REQUEST FOR QUALIFICATIONS FOR CONSULTANT SERVICES FOR<br />

SONOMA COUNTY TRANSPORTATION AUTHORITY<br />

Organization Name: ______________________________ Telephone: ______________<br />

Address:<br />

Contact Person:<br />

Email Address:<br />

__________________________________________<br />

__________________________________________<br />

__________________________________________<br />

__________________________________________<br />

__________________________________________<br />

Workers’ Compensation<br />

Do you have limits as required by the Labor Code of the State of Cali<strong>for</strong>nia?<br />

______________________________________________________________________<br />

General Liability Insurance<br />

Existing Limits: __________________________________________________________<br />

If your existing limits are less than required by SCTA, what limits can/will you obtain <strong>for</strong><br />

this contract?<br />

______________________________________________________________________<br />

Automobile Liability Insurance<br />

Existing Limits: __________________________________________________________<br />

If your existing limits are less than required by SCTA, what limits can/will you obtain <strong>for</strong><br />

this contract?<br />

______________________________________________________________________<br />

Professional Liability Insurance<br />

Existing Limits: __________________________________________________________<br />

If your existing limits are less than required by SCTA, what limits can/will you obtain <strong>for</strong><br />

this contract?<br />

______________________________________________________________________

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