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Search results with tag "Acord 855"
Form PERM 33 (July 2015) Highway Work Permit Application ...
www.dot.ny.govACORD 855. Addendum is acceptable evidence of the required coverage. Certificate Holder should be indicated as New York State Department of Transportation, with the address of the issuing office. • A fully executed . Undertaking Agreement.
SAMPLE ACORD-855 - NYS Construction Certificate of ...
ogs.ny.govAUTHORIZED REPRESENTATIVE SIGNATURE DATE (MM/DD/YYYY) Yes, by specific policy provision Yes, by endorsement No and no other option is available with this insurer M. Excess / umbrella policy is primary and non-contributory for additional insureds Yes and no other option is available with this insurer No changes made