Certification by Contractor's Ins BrokerCERTIFICATION BY CONTRACTOR'S INSURANCE BROKER
This Document Must be Fully Executed By Contractor's
Insurance Broker and Submitted With the Bid
I� Robert R. Rittenhouse , am an authorized representative of
(individual's name and brokerage name)
USI Insurance Services
(Insurance Company)
This company is the insurance broker
for ERS Industrial Services, Inc. ("Contractor")
(Contractor)
By my signature below, I hereby attest to the following:
1. I have reviewed the insurance requirements for the South Tahoe Public Utility
District's 2024 Filter Rehabilitation Project ("Project"), including the requirements set forth in
Section 00 73 00, Supplementary Conditions, Part 2.01 of the Contract Documents.
2. The Contractor is eligible to be insured for the policies necessary to satisfy the
insurance requirements for the Project.
This certification is not intended to be binding of c rage and do of odify and/or alte e
terms and conditions of the insurance policies is ed Cont
r.
Date:
(Signature of authorized 14preseinfatie)
for
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California )
ss.
County of coo- k C�JZ )
On 12 H before me, C �t� W M iU• M 5 , personally appeared
who proved to me on the basis of satisfactory evidence to be the
person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they
executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the
instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph
is true and correct.
WITNESS y hand an fficial seal.
Not ry Public
t*RIMM1401" WILLIAMS
MUry Public - California
Santa Cru2 County
7ARIEL
Commission 0 2405984
y Comm. Expires May 27, 2026
FEBRUARY 2024 SECTION 00 4100
2024 FILTER REHABILITATION PROJECT BID FORMS
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