1-Insurance Coverage Declaration.pdf

This is an Insurance Coverage Declaration form for contractors bidding on a county contract opportunity. The document requires contractors to complete the form and attach comprehensive insurance policies with all endorsements to their proposals, with failure to comply resulting in proposal rejection. The form specifies three mandatory insurance types: Commercial General Liability coverage of $2,000,000 aggregate/$1,000,000 per occurrence with General Aggregate limits applying separately to the contractor or at least twice the required occurrence limit; Comprehensive Automobile and Water Vehicle Liability covering any automotive equipment used in service performance with minimum limits of $1,000,000 per occurrence combined single limit including Physical Damage Insurance for owned or rented machinery, tools, equipment, office trailers, and vehicles; and Worker's Compensation with employer's liability coverage of at least $1,000,000 per occurrence for each accident or illness.

The insurance requirements include specific provisions that the Worker's Compensation policy must include a clause stating it cannot be cancelled or materially changed without thirty days prior written notice to the County. Companies with owner/operators who have filed a "Notice of Election to be Exempt" must supply a signed copy of this notice, and any exemption must meet applicable Worker's Compensation law requirements. The form includes a table for contractors to declare their insurance carrier, type of coverage, coverage limits in dollars, and expiration dates for General Liability, Commercial Auto, and Worker's Compensation policies, ensuring the County has complete documentation of the contractor's insurance compliance before award consideration.