26-004QP_-_Insurance_Transmittal_Form.pdf

Edition 03/2025

City of Seattle CONSULTANT CONTRACT

INSURANCE REQUIREMENTS TRANSMITTAL FORM

CITY STAFF ONLY: COMPLETE ALL YELLOW FIELDS

Contract: On-Call Pedestrian Wayfinding Contract Number: 26-004QP Contract Manager: Peter Samuels Department: Seatle Department of Transportation Telephone: 206-962-7925

This Insurance Requirements and Transmittal Form shall serve as an attachment and/or exhibit form to the On-Call Pedestrian Wayfinding (“Contract”) and shall be interpreted and applied together as a single contractual instrument between the City of Seattle (“City”) and (“Consultant”).

CONSULTANT: SEND THIS FORM TO YOUR INSURANCE PROFESSIONAL TO COMPLETE THE

GREEN BOX AND TO ENSURE COMPLIANCE WITH ALL THE COVERAGE REQUIREMENTS, TERMS

AND CONDITIONS REQUIRED BY THE CITY OF SEATTLE.

INSURANCE REPRESENTATIVE – ATTACH THIS FORM TO INSURANCE CERTIFICATION SUBMITTED TO THE CITY

COMPLETE THESE FIELDS SO THAT WE MAY CONTACT YOU IF NECESSARY. (REQUIRED)

NAME: POSITION:

NAME OF COMPANY:

EMAIL: TELEPHONE: FAX:

SEND ORIGINAL CERTIFICATION WITH COPY OF CGL ADDITIONAL INSURED ENDORSEMENT OR

BLANKET ADDITIONAL INSURED POLICY WORDING TO: THE CITY OF SEATTLE

ATTN: Risk Management

P.O. BOX 94669

SEATTLE, WA 98124-4669

In the “Certificate Holder” field of the certificate of insurance, write “Attention: City of Seattle”

Upon award of the Contract, the Consultant shall maintain continuously throughout the entire term of the Contract, at no expense to the City, the following insurance coverage and limits of liability as checked below:

1. STANDARD INSURANCE COVERAGES AND LIMITS OF LIABILITY REQUIRED:

Commercial General Liability (CGL) or equivalent insurance including coverage for:

Premises/Operations, Products/Completed Operations, Personal/Advertising Injury, Contractual and Stop Gap/Employers Liability (coverage may be provided under a separate policy). Minimum limit of liability shall be $1,000,000 each occurrence Combined Single Limit bodily injury and property damage (“CSL”) $2,000,000 Products/Completed Operations Aggregate $2,000,000 General Aggregate $1,000,000 each accident/disease—policy limit/disease—each employee WA Stop Gap/Employer’s Liability

Automobile Liability insurance for owned, non-owned, leased or hired vehicles, as applicable, written on a form CA 00 01 or equivalent WITH MINIMUM LIMITS OF LIABILITY OF

$1,000,000 CSL.

Worker's Compensation insurance for Washington State as required by Title 51 RCW.

2. ADDITIONAL COVERAGES AND/OR INCREASED LIMITS:

☐ UMBRELLA OR EXCESS LIABILITY “follow form” insurance over primary CGL and Automobile Liability insurance limits, if necessary, to provide total minimum limits of liability of $ CSL. These required total minimum limits of liability may be satisfied with primary limits or any combination of primary and umbrella/excess limits.

☐ CONTRACTOR’S POLLUTION LIABILITY insurance with minimum limits of liability of ☐$1,000,000 or ☐ $ CSL each claim.

☐ AVIATION LIABILITY insurance for bodily injury, death, property damage, contractual and passenger liability with minimum limits of ☐$1,000,000 or ☐ $ CSL each occurrence.

☐ WATERCRAFT/P&I LIABILITY insurance with minimum limits of ☐$1,000,000 or ☐$ CSL each occurrence.

☐ FEDERAL MARITIME insurance with:

☐U.S.L.&H. minimum limits ☐ $1,000,000 or ☐ $ .

☐Jones Act minimum limits ☐ $1,000,000 or ☐$ .

☒ PROFESSIONAL LIABILITY (E&O/TECHNICAL E&O) insurance appropriate to the consultant’s profession. The minimum limit shall be ☒$1,000,000 or ☐ $2,000,000 each claim.

☐ CRIME FIDELITY, THEFT, DISAPPEARANCE & DESTRUCTION LIABILITY (TO INCLUDE

EMPLOYEE THEFT, WIRE TRANSFER, FORGERY & MAIL COVERAGE, AND CLIENT

COVERAGE) with minimum limit ☐$1,000,000 or ☐ $ per occurrence and in the aggregate. Coverage shall include ‘Joint Loss Payable’ ISO form CR 20 15 10/10 or equivalent;

and “Provide Required Notice of Cancellation to Another Entity’ SIO form CR 20 17 10/10.

☐ TECHNOLOGY ERRORS & OMISSION (E&O) INSURANCE including but not limited to security and privacy liability with minimum limit of ☐$1,000,000 or ☐ $ each claim.

☐ INFORMATION TECHNOLOGY–CYBER LIABILITY (NETWORK SECURITY LIABILITY AND

PRIVACY LIABILITY) with minimum limit ☐ $1,000,000 or ☐ $ per occurrence and in the aggregate. Coverage shall include, but not be limited to, coverage for any actual or alleged breach of duty, neglect, error, act, mistake, omission, or failure arising out of Consultant’s Internet and Network Activities including coverage for, but not limited to, the following events: an attack that has the intent to affect, alter, copy, corrupt, destroy, disrupt, damage, or provide unauthorized access or unauthorized use of Consultant’s computer system; Computer Crime or Information Theft; Denial of Service; Extortion; Introduction, implantation, or spread of a Computer Virus; Loss of Service; Identity Theft; Infringement; Electronic data loss and restoration; Unauthorized Access or Use, including the gaining of access to Consultant’s computer systems by an unauthorized person or persons or an authorized person in an unauthorized manner. Coverage shall include notification and other expenses incurred in remedying a privacy breach and costs to investigate and restore data.

☐ OTHER: (to be provided by Risk Management).

MARINE:

☐ MARINE GENERAL LIABILITY covering bodily injury including wrongful death, third party property damage including loss of use thereof, premises/operations liability, products/completed operations, personal/advertising injury, contractual liability, stop gap or employer’s liability (for monopolistic state projects), fire damage legal liability, action over indemnity, sudden and accidental pollution, amended exclusions for care, custody and control and watercraft liability to cover work related to this project.

Coverage also to extend to cover stevedores legal liability, wharfinger’s legal liability, terminal operator’s liability and charterer’s legal liability, when applicable. Coverage shall be on an occurrence basis and limits of liability shall not be less than ☐$1 million or ☐$ each occurrence and $ in the aggregate.

The General Aggregate limit is to apply separately to each project.

☐ HULL AND MACHINERY INSURANCE covering all owned and/or operated watercraft used in performing work and/or services related to this project. Such coverage shall be written on the American Institute Hull Clauses (6/2/1977) or equivalent and shall include full collision and tower’s liability, if not provided under the Protection and Indemnity coverage. Amount of coverage shall be equal to the fair market value of the hull and machinery. Any “as owner” or “other than owner” limitations of liability are to be deleted or amended not to apply to project owner.

☐ PROTECTION AND INDEMNITY INSURANCE covering all owned or operated watercraft used in performing work and/or services related to this project. Such coverage shall be written on the SP23 (1956) Form or equivalent and shall include full collision and tower’s liability, if not provided in the Hull and Machinery coverage. Coverage also to include contractual liability extension, crew liability (if not in the Maritime

Employer’s Liability coverage) and excess collision and tower’s liability (excess of any collision and tower’s liability provided in the Hull and Machinery coverage). Limits of liability shall not be less than ☐$1 million or

☐$ each vessel separately insured. Any “as owner” or “other than owner” limitations of liability are to be deleted or amended not to apply to project owner.

☐ VESSEL POLLUTION INSURANCE covering all owned or operated watercraft used in performing work and/or services related to this project. Such coverage shall be written on the Water Quality Insurance Syndicate policy form, or equivalent, and shall include bodily injury. Vessel owner or operator shall also have Certificate of Financial Responsibility pursuant to OPA90, Coast Guard Regulations and State of California, as required. Any “as owner” or “other than owner” limitations of liability are to be deleted or amended not to apply to project owner. Limits of liability shall be in accordance with OPA90, but not less than ☐$1 million or

☐$ each occurrence.

☐ CHARTERER'S LEGAL LIABILITY (if not included in #1 above) for any chartered, leased or borrowed watercraft used in performing work and/or services related to this project. Such coverage shall include but not be limited to third party bodily injury and property damage, including damage to the chartered, leased or borrowed watercraft and including damage to cargoes carried on said watercraft. Coverage to also include pollution liability. Limit of liability shall not be less than ☐$1 million or ☐$ per occurrence.

☐ STATUTORY WORKERS' COMPENSATION, EMPLOYER'S LIABILITY INSURANCE, JONES ACT

LIABILITY AND MARITIME EMPLOYERS’ LIABILITY extended to include coverage for U. S. Longshore & Harbor Workers Act. Policy shall contain an Alternate Employers endorsement in favor of the City and its partners. Such insurance shall provide statutory limits for compensation coverage and with minimum limits of $1 million for employers and maritime employer’s liability.

☐ SHIP REPAIRER’S OR MARINA OPERATOR’S LEGAL LIABILITY INSURANCE COVERING THE

VENDOR’S LIABILITY FOR LOSS OR DAMAGE, INCLUDING LOSS OF USE, TO OWNERS OF

WATERCRAFT WHILE IN THE VENDOR’S CARE, CUSTODY AND CONTROL FOR THE PURPOSE OF

BEING REPAIRED OR SERVICED.

MINIMUM LIMITS OF LIABILITY SHALL BE $ EACH VESSEL

☐ TOWER’S LEGAL LIABILITY INSURANCE

Any tower hired by the Vendor or any subcontractor shall carry for any tow of the vessel within ……. Such insurance limits shall be for not less than the portion of the Total Contract Price allocable to such vessel (and in no event less than the replacement cost for such vessel), to cover loss, damage and/or expense to the City of Seattle arising out of such towage.

☐ BUMBERSHOOT LIABILITIES covering excess liabilities for the above marine coverages. Such coverage shall be on a follow-form basis with a drop-down provision where primary coverage is aggregated. Limits of liability shall not be less than $ million.

IT/CYBER

☐ TECHNOLOGY ERRORS & OMISSION / PROFESSIONAL LIABILITY INSURANCE WITH AN

AGGREGATE LIMIT OF LIABILITY NOT LESS THAN $ MILLION DOLLARS

($ ,000,000). Such insurance shall cover any and all errors, omissions or negligent acts in the delivery or performance of products, services and/or licensed programs under this agreement.

Such Professional Liability insurance shall include coverage for claims and losses with respect to network risks (such as data breaches, unauthorized access/use, identity theft, invasion of privacy, damage/loss/theft of or to data, degradation, downtime, etc.) and intellectual property infringement, such as copyrights, trademarks, service marks and trade dress. The Professional Liability Insurance retroactive coverage date shall be no later than the effective date of this agreement. Suppler/Vendor shall continuously maintain such insurance or purchase an extended reporting period providing that claims first made and reported to the insurance company within three (3) years after termination of the agreement will be deemed to have been made during the policy period.

☐ INFORMATION TECHNOLOGY –CYBER LIABILITY (NETWORK SECURITY LIABILITY AND PRIVACY LIABILITY) WITH MINIMUM LIMIT $ PER OCCURRENCE AND IN THE AGGREGATE. This shall include, but not be limited to, coverage for any actual or alleged breach of duty, neglect, error, act, mistake, omission, or failure arising out of Vendor’s Internet and Network Activities including coverage for, but not limited to, the following events: An attack that has the intent to affect, alter, copy, corrupt, destroy, disrupt, damage, or provide unauthorized access or unauthorized use of Vendor’s computer system; Computer Crime or Information Theft; Denial of Service; Extortion; Introduction, implantation, or spread of a Computer Virus; Loss of Service; Identity Theft; Infringement; Electronic data loss and restoration; Unauthorized Access or Use, including the gaining of access to Vendor’s computer systems by an unauthorized person or persons or an authorized person in an unauthorized manner.

☐ SUBLIMIT FOR NOTIFICATION COSTS: $ PER OCCURRENCE

3. CITY AS ADDITIONAL INSURED; PRODUCTS-COMPLETED OPERATIONS: Consultant shall include “The City of Seattle and its officers, officials, employees, agents and volunteers” as additional insured to all applicable Liability insurance coverages (CGL/MGL and Commercial Auto) listed and checked above except Professional Liability and Workers’ Comp. Additional Insured status shall include Products/Completed Operations. All insurance shall be primary and noncontributory with any insurance or self-insurance coverage or limits of liability maintained by the City, and in the form of a duly issued additional insured endorsement and attached to the policy or by the appropriate blanket additional insured policy wording, and in any other manner further required by Consultant’s insurance coverage to provide the City of Seattle additional insured coverage as set forth herein. The City shall be additional insured for the full available limits of liability maintained by the Contractor, whether such limits are primary, excess, contingent or otherwise, irrespective of whether the Certificate of Insurance provided by the Consultant describes limits lower than those maintained by the Consultant.

4. NO LIMITATION OF LIABILITY: Insurance coverage and limits of liability as specified herein are minimum coverage and limit of liability requirements only. Nothing in the City of Seattle’s requirements for minimum insurance coverage shall be interpreted to limit or release liability of the Consultant or any of the Consultant’s insurers. The City shall be an additional insured regarding the total limits of liability maintained, whether such limits are primary, excess, contingent or otherwise.

5. REQUIRED SEPARATION OF INSURED PROVISION; CROSS-LIABILITY EXCLUSION AND

OTHER ENDORSEMENTS PROHIBITED: Consultant’s insurance policy shall include a “separation of insureds” or “severability” clause that applies coverage separately to each insured and additional insured, except with respect to the limits of the insurer’s liability. Consultant’s insurance policy shall not contain any provision, exclusion or endorsement that limits, bars, or effectively precludes the City of Seattle from coverage or asserting a claim under the Consultant’s insurance policy on the basis that the coverage or claim is brought by an insured or additional insured against an insured or additional insured under the policy. Consultant’s CGL policy shall NOT include any of the following Endorsements (or their equivalent endorsement or exclusions): (a) Contractual Liability Limitation, (CGL Form 21 39 or equivalent), b) Amendment Of Insured Contract Definition, (CGL Form 24 26 or equivalent), (c) Limitation of Coverage to Designated Premises or Project, (CGL Form 21 44 or equivalent), (d) any endorsement modifying or deleting the exception to the Employer’s Liability exclusion, (e) any “Insured vs. Insured” or “cross-liability” exclusion, and (f) any type of punitive, exemplary or multiplied damages exclusion. Consultant’s failure to comply with any of the requisite insurance provisions shall be a material breach of, and grounds for, the immediate termination of the Contract with the City of Seattle; or if applicable, and at the discretion of the City of Seattle, shall serve as grounds for the City to procure or renew insurance coverage with any related costs of premiums to be repaid by Consultant or reduced and/or offset against the Contract.

6. SUBSTITUTION OF SUBCONSULTANT’S INSURANCE: If portions of the scope of work are subcontracted, the subconsultant or subcontractor may provide the evidence of insurance for the subcontracted body of work provided all the requirements specified in this Insurance Transmittal Form are satisfied.

7. NOTICE OF CANCELLATION: The above checked insurance coverages shall not be canceled by Consultant or Insurer without at least forty-five (45) days written notice to the City, except ten (10) days’ notice for non-payment of premium.

8. CLAIMS MADE FORM: If any insurance policy is issued on a “claims made” basis, the retroactive date shall be prior to or coincident with the effective date of the Contract. The Consultant shall either maintain “claims made” forms coverage for a minimum of three years following the expiration or earlier termination of the Contract, providing the City with a Renewal Certificate of Insurance annually; purchase an extended reporting period ("tail") for the same period; or execute another form of guarantee acceptable to the City to assure the Consultant’s financial responsibility for liability for services performed.

9. INSURER’S A.M. BEST’S RATING: Each insurance policy shall be issued by an insurer rated A-:

V or higher in the A.M. Best's Key Rating Guide, unless a surplus lines placement by a surplus lines placement under RCW chapter 48.15, licensed Washington State surplus lines broker, or as may otherwise be approved by the City.

10. SELF-INSURANCE: The City acknowledges that the Consultant may employ self-insured and/or alternative risk financing and/or capital market risk financing programs for some or all of its coverages. The term “insurance” wherever used herein shall include any such self-insured and/or alternative risk financing and/or capital market risk financing programs. The Consultant shall be liable for any self-insured retention or deductible portion of any claim for which insurance is required.

11. EVIDENCE OF INSURANCE (NOT APPLICABLE TO WASHINGTON STATE WORKERS

COMPENSATION): Consultant must provide the following list of evidence of insurance:

a) A certificate of liability insurance evidencing coverages, limits of liability and other terms and conditions as specified herein;

b) An attached City of Seattle designated additional insured endorsement or blanket additional insured wording to the CGL/MGL or other additional insurances required (and if required Consultant’s Pollution Liability insurance policy).

c) A copy of all other amendatory policy endorsements or exclusions of Consultant’s insurance CGL/MGL policy that evidences the coverage required.

At any time upon the City’s request, Consultant shall also cause to be timely furnished a copy of declarations pages and schedules of forms and endorsements. In the event that the City tenders a claim or lawsuit for defense and indemnity invoking additional insured status, and the insurer either denies the tender or issues a reservation of rights letter, Consultant shall also cause a complete and certified copy of the requested policy to be timely furnished to the City of Seattle.

Send evidence of insurance to the City at the addresses at the top of this form.

For questions or issues about insurance, contact the contracts manager addressed at the top of this form.

NOTE: CERTIFICATES WITHOUT ATTACHED ADDITIONAL INSURED ENDORSEMENT OR BLANKET

ADDITIONAL INSURED COVERAGE FOR THE CITY OF SEATTLE WILL NOT BE APPROVED!