19- RR Ins Application and Policy.pdf
PDF 232 KB Posted
- Solicitation number
- S-KS0510-00017594
- Issued by
- Oregon
About this file
This is a Railroad Protective Liability (RPL) Insurance Application and Policy document issued by a railroad entity with offices in Jacksonville, Florida. The form is designed for contractors performing work on or near railroad property as part of the Wastewater System Capacity Improvements Project in St. Helens, Oregon. Contractors have two options for obtaining required RPL coverage: they may provide their own private policy with coverage limits of $2 million per occurrence and $6 million aggregate, with the railroad listed as the named insured, or they may secure coverage through the railroad itself. The application requests comprehensive information about the designated contractor, including general liability and umbrella insurance carrier details, work location and description, project duration and cost, and whether the contractor will perform work within 50 feet of railroad tracks. The form also inquires about railroad involvement, including whether flagmen or supervisors will be present, whether railroad employees will perform work, and whether railroad equipment will be assigned to the contractor.
If contractors elect to obtain RPL coverage through the railroad, the cost is $1,150 for a 60-day policy period. Contractors selecting this option must complete the RPL application form in its entirety and submit proof of payment. The railroad requires that contractors' general liability and umbrella policies remove contractual exclusions for work within 50 feet of railroad tracks, hold the railroad harmless, and name the railroad as an additional insured. All required documentation must be submitted to the Real Estate Department at the Jacksonville address, with inquiries regarding invoicing directed to Realestateapplications@gwrr.com.
View the file
Other files
Show all 22
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Railroad Protective Liability Policy
If providing your own private policy:
1. The named insured on the policy must match the Certificate Holder listed in the email accompanying this attachment.
2. The policy must carry coverage limits of $2 million per occurrence and $6 million aggregate.
3. Please submit this policy along with all other items requested in the email.
o You do not need to complete the form below.
If securing the policy through the Railroad:
• The cost of the RPL policy is $1,150 for 60 days.
Please submit the following:
1. The completed form below, filled out in its entirety.
2. Proof of payment for the $1,150. (If an Invoice is needed, please email Realestateapplications@gwrr.com with the file ID in the subject line) mailto:Realestateapplications@gwrr.com
Railroad Protective Liability Application
Named Insured Railroad:
Address: c/o Real Estate Dept, 13901 Sutton Park Dr., S., Ste. 270, Jacksonville, FL 32224
Name of Designated Contractor:
Address:
Contractors GL Limits:
Carrier:
Contractors Umbrella Limits:
Carrier:
Will the Contractor be holding the Railroad Harmless? Yes No Will the Railroad be listed as an “Additional Insured” on the Contractor’s CGL and Umbrella policies? Yes No Will the Contractor’s GL & Umbrella policies remove the contractual exclusion for work within 50’ of a Railroad? Yes No
Railroad Protective Limits Required: yes Per Occurrence: $2 Million Aggregate: $6 Million
Name & Address for Whom Work is Being Performed:
Description of Job:
Approximate Length of Job (years/months):
Total Cost of Job: Cost of Work Within 50’ of Tracks:
Daily Train Traffic: Freight: Passenger:
Will there be any Railroad flagmen/supervisors? Yes No Will there be any other work performed by any railroad employees? Yes No If yes, please describe:
Will there be any Railroad equipment assigned to the contractor? Yes No If yes, please describe:
Signature: Date:
Printed Name:
Title:
| Contractors Umbrella Limits: |
| Will the Contractors GL Umbrella policies remove the contractual exclusion for work within: Off |
| undefined: Off |
| Total Cost of Job: |
| Cost of Work Within 50 of Tracks: |
| Daily Train Traffic: |
| Freight: |
| Passenger: |
| undefined_2: Off |
| undefined_3: Off |
| If yes please describe: |
| undefined_4: Off |
| If yes please describe_2: |
| Date: |
| Printed Name 1: |
| Printed Name 2: |
| Railroad Name: |
| Name of Designated Contractor: |
| Address of Designated Contractor: |
| GL Limits: |
| GL Insurance Carrier: |
| Umbrella Insurance Carrier: |
| Name for Whom Work is Being Performed: |
| Address for Whom Work is Being Performed: |
| Description of Job: |
| Description of Job 2: |
| Approximate Length of Job - months: |
File details come from the government source that posted it. Updated .