4-4663 - Letcher County - Insurance Coverage Declaration.pdf
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- Solicitation number
- Appraisal - R 1
- Issued by
- Knott County, Kentucky
About this file
This is an Insurance Coverage Declaration form from the Letcher County Fiscal Court for their Property Buyout Program. The document outlines specific insurance requirements for contractors proposing to work on the program, detailing three primary types of mandatory insurance coverage: Commercial General Liability, Comprehensive Automobile and Water Vehicle Liability, and Worker's Compensation. Each coverage type has precise monetary limits, with Commercial General Liability requiring $2,000,000 aggregate and $1,000,000 per occurrence, Automobile Liability requiring $1,000,000 combined single limit, and Worker's Compensation requiring $1,000,000 per occurrence for each accident or illness.
The form provides a table for contractors to complete, listing their insurance carrier, type of coverage, coverage limits, and expiration dates for each insurance policy. Notably, the document emphasizes that failure to attach the required insurance policies and complete the declaration may result in a rejected proposal. Additionally, the Worker's Compensation policy must include a provision that it cannot be cancelled without providing 30 days' prior written notice to the County, and firms with owner/operators who have filed for exemption must supply 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 GeneralLiability–intheamountoftwomilliondollars($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. ComprehensiveAutomobileandWaterVehicleLiability–coveringanyautomotiveequipmenttobe 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 ($1,000,000.00) per occurrence for each accident or illness. The Worker’s Compensation policy shall state that it cannot be cancelled or materially changedwithoutfirstgivingthirty(30)dayspriornoticethereofinwritingtotheCounty.Firmsthat haveowner/operatorsthathavefileda“NoticeofElectiontobeExempt”shallsupplyasignedcopy ofsaidnotice.Anysuchexemptionshallmeettherequirementsthatualifyforanexemptionunderthe applicable Worker’s Compensation law.
Insurance Carrier Type of Coverage Limit ($) Expiration Date
General Liability
Commercial Auto
Worker’s Compensation
File details come from the government source that posted it. Updated .