City of Burlington: Certificate of Insurance Your Name First Last PhoneYour Email Address* Enter Email Confirm Email DepartmentAirport TerminalAirport ParkingAirport Industrial ParkAirport Other BuildingsAirport AirfieldBED: General Manager Executive SecBED: Customer Energy ServicesBED: Finance AccountingBED: Risk Management Gov't AffairsBED: EngineeringBED: Operations - LinecrewBED: Operations - MeteringBED: Operations - TechsBED: Operations - TbshooterBED: Operations - DispatchBED: McNeil Station - Aux OperatorBED: McNeil Station - Shift SupervisorBED: McNeil Station - Station OperatorBED: McNeil Station - YardworkerBED: McNeil Station - MaintenanceBED: McNeil Station - MiscCity Hall: CEDOCity Hall: MayorCity Hall: Clerk/TreasurerCity Hall: Planning ZoningCity Hall: AttorneyCity Hall: ITCity Hall: AssessorDPW: Admin EngineeringDPW: SidewalkDPW: RecyclingDPW: Right of WayDPW: TrafficDPW: WaterDPW: WastewaterDPW: Equipment MaintenanceDPW: Code EnforcementParking: 47 S Winooski AveParking: 60 College StreetParking: 45 Cherry Street (Lakeview)Parking: Westlake Garage (attached to Lakeview)Station #1: 136 South Winooski AveStation #2: 132 North AveStation #3: 20 Mansfield AveStation #4: 1397 North AveStation #5: 23 Ferguson AveAdministration: 1 North AveLibraryMarketplaceHuman ResourcesFirehouse BuildingParks & Rec: Bldg Maintenance, 645 Pine StreetParks & Rec: Parks Maintenance, 645 Pine StreetParks & Rec: Cemetary: LakeviewParks & Rec: Cemetary: ElmwoodParks & Rec: Cemetary: Green MountainParks & Rec: North BeachParks & Rec: Oakledge ParkParks & Rec: Leddy ParkParks & Rec: Calahan ParkParks & Rec: Schifilliti ParkParks & Rec: Schmanska ParkParks & Rec: Community BoathouseParks & Rec: Arborist StaffPolice Dept: CivilianPolice Dept: SwornTelecomName of Certificate Holder First Last Cert-holder Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email for Cert Holder Fax numberNature of the relationship with the certificate holder A standard certificate of insurance will be issued with the following applicable coverages: general liability, automobile liability, workers' compensation, and umbrella. If you require other than the standard coverages listed, please list below: Does the certificate holder need to be included as additional insured? Yes No Any special wording or remarks: Note: Our procedure is to send the certificate directly to the certificate holder and we will email you an original as well for your records. If you would like this certificate handled in a different manner, please list below: Δ