4-4663 - Letcher County - Insurance Coverage Declaration.pdf
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- Attached to
- Invitation for Bid-Environmental Database Review
- Solicitation number
- Environmental Database Review-Round 1
- Issued by
- Knox County, Kentucky
About this file
This document is an Insurance Coverage Declaration form from Letcher County Fiscal Court for their Property Buyout Program, requiring contractors to provide detailed insurance coverage documentation as part of a proposal submission. The form outlines three specific insurance requirements: Commercial General Liability coverage of $2 million aggregate/$1 million per occurrence, Comprehensive Automobile and Water Vehicle Liability coverage of $1 million per occurrence, and Worker's Compensation with employer's liability coverage of $1 million per occurrence.
The form mandates that contractors complete the insurance coverage table by specifying their insurance carrier, type of coverage, coverage limits, and expiration dates for each insurance category. Failure to attach the required insurance policies and complete the form may result in proposal rejection. The document also includes specific provisions for owner/operators who have filed for worker's compensation exemptions, requiring them to supply a signed copy of their "Notice of Election to be Exempt" that meets applicable legal requirements.
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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 .