4-4663 - Letcher County - Insurance Coverage Declaration.pdf
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- Attached to
- Invitation for Bid- Title Services - R-1
- Solicitation number
- Title Round 1
- Issued by
- Laurel 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 specifies three primary insurance coverage requirements: Commercial General Liability with a $2,000,000 aggregate and $1,000,000 per occurrence limit, Comprehensive Automobile and Water Vehicle Liability covering automotive equipment with a $1,000,000 combined single limit, and Worker's Compensation with employer's liability coverage of at least $1,000,000 per occurrence for each accident or illness.
The document mandates that contractors complete the insurance coverage table, listing their insurance carrier, type of coverage, coverage limits, and expiration dates. Failure to attach the required insurance policies and complete the form may result in proposal rejection. The Worker's Compensation policy includes a specific requirement that it cannot be cancelled without providing thirty days' prior written notice to the County. For firms with owner/operators who have filed a "Notice of Election to be Exempt", a signed copy of that notice must be supplied, ensuring compliance with applicable Worker's Compensation laws.
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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 .