Attachment_A.pdf

Attachment A: Insurance Requirements

Notice to Responders.

The Responder is required to submit Certificates of Insurance acceptable to the State as evidence of insurance coverage requirements prior to commencing work under this demonstration.

Notice to Insurer.

The Responder’s insurance company(ies) waives its right to assert the immunity of the State as a defense to any claims made under said insurance.

Insurance certificate holder should be addressed as follows:

State of Minnesota Department of Transportation 395 John Ireland Boulevard St. Paul, MN 55155

Coverages. Responder is required to maintain and furnish satisfactory evidence of the following insurance policies:

Commercial General Liability Insurance. Responder is required to maintain insurance protecting it from claims for damages for bodily injury, including sickness or disease, death, and for care and loss of services as well as from claims for property damage, including loss of use which may arise from operations during the demonstration whether the operations are by the Responder or by anyone directly or indirectly employed by the Responder during the demonstration. Insurance minimum limits are as follows:

$2,000,000 – per occurrence $2,000,000 – annual aggregate $2,000,000 – annual aggregate – applying to Products/Completed Operations

The following coverages shall be included:

• Premises and Operations Bodily Injury and Property Damage

• Personal and Advertising Injury

• Blanket Contractual Liability

• Products and Completed Operations Liability

• Other; if applicable, please list__________________________________

• State of Minnesota named as an Additional Insured, to the extent permitted by law

Commercial Automobile Liability Insurance. Responder is required to maintain insurance protecting it from claims for damages for bodily injury as well as from claims for property damage resulting from the ownership, operation, maintenance or use of all owned, hired, and non-owned autos which may arise from operations under this demonstration. Insurance minimum limits are as follows:

$2,000,000 – per occurrence Combined Single limit for Bodily Injury and Property Damage

In addition, the following coverages should be included: Owned, Hired, and Non-owned Automobile.

Workers’ Compensation Insurance. Statutory Compensation Coverage. Except as provided below, Responder must provide Workers’ Compensation insurance for all its employees. Insurance minimum limits are as follows:

$100,000 – Bodily Injury by Disease per employee $500,000 – Bodily Injury by Disease aggregate $100,000 – Bodily Injury by Accident

If Minn. Stat. § 176.041 exempts Responder from Workers’ Compensation insurance or if the Responder has no employees in the State, Responder must provide a written statement, signed by an authorized representative, indicating the qualifying exemption that excludes Responder from the Minnesota Workers’ Compensation requirements.