2-Insurance Coverage Declaration.pdf
PDF 67 KB Posted
- Solicitation number
- 731368 - 1
- Issued by
- Larue County, Kentucky
About this file
This is an Insurance Coverage Declaration form that contractors must complete as part of a proposal submission to a County. The document outlines mandatory insurance requirements that must be met, including the attachment of actual insurance policies and endorsements to the proposal, with failure to comply resulting in proposal rejection. The form requires contractors to provide three specific types of coverage: Commercial General Liability insurance with $2,000,000 aggregate/$1,000,000 per occurrence limits, Comprehensive Automobile and Water Vehicle Liability covering equipment used in service performance with $1,000,000 per occurrence combined single limit, and Worker's Compensation with employer's liability coverage of $1,000,000 per occurrence.
The insurance requirements include specific provisions such as the General Aggregate limit applying separately to the contractor or being at least twice the occurrence limit, physical damage insurance for owned or rented equipment, and Worker's Compensation policies that cannot be cancelled without 30 days written notice to the County. The form includes a table where contractors must list their insurance carrier, type of coverage, coverage limits, and expiration dates for General Liability, Commercial Auto, and Worker's Compensation policies. Special provisions allow for owner/operators who have filed exemption notices under Worker's Compensation law to provide signed copies of such notices instead of traditional coverage.
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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 .