4-PD 1.1 Attachment E Insurance Instructions.pdf
PDF 756 KB Posted
- Attached to
- Pavement Marking Services and Related Products
- Solicitation number
- RFP 25-028
- Issued by
- Williamson County, Texas
About this file
This document is an insurance certificate instructions and sample form from the City of Round Rock, Texas, dated August 2024. The document provides comprehensive guidance for completing a Certificate of Liability Insurance, detailing specific requirements for insurance coverage when doing business with the city. Key instructions cover various sections of the insurance certificate, including mandatory information about the insurance producer, insured party, insurers, policy types, and required endorsements.
The instructions mandate that all insurance companies must be authorized to do business in Texas and require specific details such as General Liability Insurance (preferably an "Occurrence" type policy), Automobile Liability Insurance coverage for various auto types, Umbrella Coverage, Workers' Compensation, and potential Builder's Risk or Professional Liability policies. Critical requirements include listing the City of Round Rock as an additional insured (with exceptions for professional liability and workers' compensation), providing a waiver of subrogation, ensuring primary and non-contributory coverage, and including a cancellation notice. The sample certificate demonstrates how these detailed instructions should be implemented, with placeholders for policy numbers, effective dates, and coverage limits across different insurance categories.
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Text version
Page 5 of 6 DATED: AUGUST 2024
(Instructions for completing and submitting a certificate to the City of Round Rock)
Complete the certificate of insurance with the information listed below as required:
A) Certificate of Insurance date
B) Producer (Insurance Agency) Information -complete name, address, telephone information, & email address.
C) Insured’s (Insurance Policy Holder) Information -complete name & address information
D) Insurer (name/names of insurance company) (The City requires all insurance companies to be Authorized to do business in the State of Texas)
E) NAIC # (National Association of Insurance Commissioners, a # that is assigned by the State to all insurance companies)
F) Insurer letter represents which insurance company provides which type of coverage from D.
G) General Liability Insurance Policy - must have an (x) in box. Also, “Occurrence” type policy -must have an
(x) in the box (occurrence policy preferred but claims made policy can be accepted with special approval)
H) This section shall be filled in with “Y” for yes under Additional Insured for all coverages, except for Professional Liability and Workers’ Compensation. There shall also be a “Y” for yes under all coverages for subrogation waived.
I) Automobile Liability Insurance – must be checked for Any Auto, All Owned Autos, Hired Autos
J) Umbrella Coverage – must be checked in this section and by occurrence whenever it is required by written contract and in accordance with the contract value.
K) Worker's Compensation and Employers Liability Insurance - information must be completed in this section of the certificate of insurance form (if applicable)
L) Builder’s Risk Policy – for construction projects as designated by the City of Round Rock.
Professional Liability Coverage – for professional services if required by the City of Round Rock.
M) Insurance Policy #’s
N) Insurance policy effective dates (always check for current dates)
O) Insurance Policy limits
P) This section is to list projects, dates of projects, or location of project. Endorsements to the insurance policy(ies) must be provided separately and not in this section. The following endorsements are required by the City of Round Rock.
(1) Adding the City of Round Rock as an additional insured. The “additional insured” endorsement is not required for professional liability and workers compensation insurance; and
(2) Waiver of Subrogation
(3) Primary and Non-Contributory
(4) Cancellation Notice
Q) City of Round Rock’s name and address information must be listed in this section.
R) Notice of cancellation, non-renewal, or material change to the insurance policy(ies) must be provided to the City of Round Rock in accordance with a cancellation notice endorsement to the policy and/or per the policy provisions based on the endorsement adding the City as an additional insured. (Sec. 1811.155, Tex. Ins. Code)
S) The certificate must be signed by the Authorized Agent in this section of the certificate form.
Page 6 of 6 DATED: AUGUST 2024
File details come from the government source that posted it. Updated .