Utility Subcontractor Checklist

Business: ________________ Project: ________________ Utility work type: ________________ Certificate due date: ________________ Review contact: ________________

Certificate holder: ________________ ________________

Limit source for this checklist: ________________

Use this checklist with the subcontractor agreement and the upstream contract. A certificate of insurance shows evidence of coverage, but endorsements and policy terms control the actual coverage.

Write the required limit from the contract in the blank column before approving the subcontractor.

Check only the items required by the subcontractor agreement or upstream contract.

• Additional insured wording is required for commercial general liability.
• Additional insured wording is required for business auto liability.
• Additional insured endorsement copy was received.
• Additional insured form number and edition were reviewed: ____________________
• Ongoing operations additional insured wording was reviewed.
• Completed operations additional insured wording was reviewed when the contract requires it.
• Primary and noncontributory wording was reviewed for commercial general liability.
• Primary and noncontributory wording was reviewed for business auto liability.
• Waiver of subrogation wording was reviewed for commercial general liability.
• Waiver of subrogation wording was reviewed for workers compensation.
• Waiver of subrogation wording was reviewed for business auto liability.
• Umbrella or excess policy follows the required underlying policies.
• Certificate holder name and address match the contract instructions.
• Notice of cancellation wording was reviewed if the contract requires it.

Use this section to match the subcontractor insurance review to the work being performed on ________________.

• Subcontractor work description matches the agreement and certificate description.
• Excavation, trenching, boring, drilling, or utility locating work was identified before approval.
• Work near gas, electric, water, sewer, fiber, rail, or other critical lines was identified before approval.
• Traffic control, blasting, tunneling, confined space, or railroad work was identified before approval if part of the subcontractor's work.
• Leased, rented, or borrowed equipment responsibilities were reviewed if the subcontractor uses equipment on the job.
• Subcontractor agreement requires insurance evidence before work starts.
• Subcontractor agreement requires updated evidence before policy expiration during the project.

Track policy periods and renewal evidence before the subcontractor continues work.

Subcontractor name: ______________________________ Reviewed by: ______________________________ Review date: ______________________________ Insurance evidence review complete: ☐ Yes ☐ No Follow up needed before work starts: ☐ Yes ☐ No

Follow up items: 1. ________________________________________________ 2. ________________________________________________ 3. ________________________________________________

Reviewer signature: ______________________________ Date: ______________________________