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SECTION 4: INSURANCE COVERAGE - please check the appropriate box below to indicate if your entity can obtain <br />each type of coverage. (Waivers may be granted in some instances.) If N/A or Other, please notate next to the field. <br />Type <br />Agency CAN obtain this <br />coverage <br />Agency CANNOT <br />obtain this coverage <br />Public Liability Insurance - $1,000,000 personal injury and property <br />damage <br />❑ <br />✓ <br />Worker's Compensation Coverage - as required by the State of <br />Washington <br />❑ <br />✓ <br />Professional Liability- Only required when providing professional <br />services, $1,000,000 error and omissions. <br />❑ <br />✓ <br />Self -Insured - Public Entities ONLY <br />1 <br />❑ <br />SECTION 5: FINAL QUESTIONS - HAVE YOU... <br />Completed all form questions <br />✓ <br />YES <br />❑ <br />NO <br />Confirmed desired project is in the appropriate budget documents <br />✓ <br />YES <br />❑ <br />NO <br />Confirmed desired project is in your CIP <br />✓ <br />YES <br />❑ <br />NO <br />Reviewed the agreement template <br />✓ <br />YES <br />❑ <br />NO <br />Confirmed Proof of Insurance <br />✓ <br />YES <br />❑ <br />NO <br />SECTION 6: SUBMISSION REQUIREMENTS <br />Please submit the form and all requested attachments to the following address by July 31 st, 5 PM <br />Council District 2 <br />megan.dunn@co.snohomish.wa.us <br />425-388-2408 <br />3000 Rockefeller Avenue, M/S 609 <br />Everett, WA 98201-4046 <br />