1-Insurance Coverage Declaration.pdf
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- Solicitation number
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- Boyd County, Kentucky
About this file
This document is an Insurance Coverage Declaration form requiring contractors to provide detailed insurance policies as part of a proposal submission. The form mandates three specific types of insurance coverage: Commercial General Liability with a $2,000,000 aggregate and $1,000,000 per occurrence limit, Comprehensive Automobile and Water Vehicle Liability with a $1,000,000 combined single limit, and Worker's Compensation with employer's liability coverage of at least $1,000,000 per occurrence. Failure to complete and attach the required insurance policies may result in proposal rejection.
The form provides a table for contractors to specify their insurance carrier details, including the type of coverage (General Liability, Commercial Auto, and Worker's Compensation), policy limits, and expiration dates. Notable requirements include that the General Aggregate limit must either apply separately to the contractor or be at least twice the occurrence limit. Additionally, the Worker's Compensation policy must include a provision that it cannot be cancelled or materially changed without providing 30 days' prior written notice to the County. Firms with owner/operators who have filed for worker's compensation exemption must submit a signed copy of their exemption notice.
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Text version
INSURANCE COVERAGE DECLARATION
Contractor shall complete the form below and attach the following insurance policies (including all endorsements) to this proposal. Failure to do so, may result in a rejected Proposal.
1. Commercial General Liability – in the amount of two million dollars ($2,000,000.00) aggregate/one million dollars ($1,000,000.00) per occurrence. The General Aggregate limit shall either apply separately to the resulting Contractor or shall be at least twice the required occurrence limit.
2. Comprehensive Automobile and Water Vehicle Liability – covering any automotive equipment to be used in performance of the service, with a minimum limit in the amount of One Million Dollars ($1,000,000.00) per occurrence combined single limit / any auto.
Physical Damage Insurance covering owned or rented machinery, tools, equipment, office trailers, and vehicles.
3. Worker’s Compensation – Proposer shall provide a policy with employer’s liability coverage with limits of not less than One Million Dollars ($1,000,000.00) per occurrence for each accident or illness. The Worker’s Compensation policy shall state that it cannot be cancelled or materially changed without first giving thirty (30) days prior notice thereof in writing to the County. Firms that have owner/operators that have filed a “Notice of Election to be Exempt” shall supply a signed copy of said notice. Any such exemption shall meet the requirements that qualify for an exemption under the applicable Worker’s Compensation law.
Insurance Carrier Type of Coverage Limit ($) Expiration Date
General Liability
Commercial Auto
Worker’s Compensation
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File details come from the government source that posted it. Updated .