Attachment_9_-_Insurance_Certifications.pdf

California Department of Aging RFO Number: RFO-2526-04 MSSP – Organizational Change Management

ATTACHMENT 9

INSURANCE CERTIFICATIONS

Offeror’s Name:

This form reminds offerors of the insurance requirements that may be imposed by this request and provides samples of some of the forms that they may be required to produce prior to being awarded an agreement.

Initial Certification Offeror acknowledges that they have reviewed and understand the insurance requirements for this request as described in Attachment 18, Sample Agreement, Exhibit E, Insurance Requirements.

Offeror acknowledges that they have reviewed and understand the sample insurance forms provided with this attachment.

Offeror certifies that, if awarded an agreement, the offeror shall provide the CDA with all required insurance documents as may be applicable, in a timely manner. This includes, but may not be limited to:

Certificates of insurance showing the offeror’s insurance coverage types and limitations.

Proof that the offeror has insured the State of California, its officers, employees, and agents. Offeror further understands that this proof shall come in the form of either:

1. An endorsement to the offeror’s insurance policy (Form CG 20 10 11 85 or as broad as),

2. A copy of the offeror’s current insurance policy that shows that the policy already insures all parties required to be insured by this Agreement.

Offeror certifies that, should Commercial General Liability insurance be required, and should the offeror use a sub-offeror to complete a portion of this Agreement, the offeror shall either:

1. Include the sub-offeror as an additional named insured under the offeror’s policy, or

2. Ensure that each sub-offeror is insured under their own Commercial General Liability policy.

Offeror acknowledges that they understand that the CDA reserves the right, at its sole discretion, to cancel a proposed award to an offeror who does not submit the required documentation described herein.

Offerors are reminded that there is no requirement to submit proof of insurance with their offer. Proof of insurance shall only be required of those firm(s) awarded a contract.

ACORD CERTIFICATE

ENDORSEMENT

Language on this certificate indicating that the State is an additional insured is not sufficient to meet the requirements of Exhibit E.

INSURED

The name in this box MUST match the name listed in the PAYEE’S LEGAL BUSINESS NAME field on the Std. 204.

TYPE OF INSURANCE and LIMITS

Each required insurance type, with the exception of Worker’s Compensation and Professional Liability, must be listed on the certificate.

CERTIFICATE HOLDER

This box must be completed as indicated in Exhibit E, section 4.

POLICY EXP.

All required insurance types must be active (not expired). If an insurance policy expiration date is impending, awarded firms are advised to be ready to submit an updated certificate with the renewal dates.

ADDITIONAL INSURED LANGUAGE

As required in Exhibit E, the “State of California, its officers, employees, and agents” must be listed as the additional insured parties. However, this endorsement may be limited to just the operations under the Agreement.

POLICY OR FORM NUMBER

Like a blanket endorsement, this traditional endorsement must be reconcilable to the insurance certificate.

A policy or form number that is also referenced on the insurance certificate must be present on the endorsement.

ADDITIONAL INSURED LANGUAGE

As required in Exhibit E, the “State of California, its officers, employees, and agents” must be listed as the additional insured parties. However, this endorsement may be limited to just the operations under the Agreement.