Attachment A-Polk County Insurance Requirements.pdf

ATTACHMENT A

Polk County, Iowa

INSURANCE REQUIREMENTS

GENERAL INSURANCE REQUIREMENTS

In order to protect both the Contractor and Polk County, Contractor shall purchase and maintain insurance throughout the term of the Agreement. This insurance shall be provided by an insurance company authorized to do business in the state of Iowa as a domestic, foreign, or surplus lines carrier, and assigned an A.M. Best Financial Strength Rating of “A-” or better.

A Certificate of Insurance evidencing the required coverage shall be submitted to Polk County for approval before any work begins. It shall be the responsibility of the Contractor to maintain the required insurance coverage at all times, and failure to do so shall not relieve the Contractor of any contractual obligation or responsibility. Failure to maintain the required insurance shall be treated as a breach of contract and shall be considered sufficient and just cause to suspend work, withhold payment(s), and/or be disqualified from receiving further contract awards.

Contractor shall provide Polk County, Iowa with thirty (30) days advanced written notice before any policy shown on the certificate of insurance is materially changed, cancelled, or non-renewed.

These insurance requirements apply with equal force, regardless of whether the work is performed by employees of the Contractor, by a subcontractor, or by an independent contractor.

Coverages and limits below shall be minimum coverage requirements and in no way limits the liability of the contractor, vendor, or service provider.

MINIMUM INSURANCE REQUIREMENTS

1. Workers’ Compensation and Employers’ Liability:

Worker’s Compensation: Statutory limits Employer’s Liability Limits: $500,000/ $500,000/ $500,000

Waiver of Subrogation: Contractor’s Workers’ Compensation policy must be endorsed to add a Waiver of Subrogation in favor of Polk County, Iowa.

2. Commercial General Liability:

Each Occurrence Limit $ 1,000,000 Personal & Advertising Injury Limit $ 1,000,000 Products & Completed Operations Limit $ 1,000,000 General Aggregate Limit $ 2,000,000 Medical Expense Limit $ 5,000

General Liability coverage shall be no less comprehensive than the coverage provided by a standard Commercial General Liability policy using CG0001. As such, the policy shall include contractual liability, premises and operations, completed operations, and XCU coverage. The policy shall be written on an “occurrence” basis, not “claims-made”.

Additional Insured: “Polk County, Iowa, its elected and appointed officials, employees, agents, their successors and assigns” shall be named as an additional insured.

In order to preserve the governmental immunities available to Polk County, Contractor’s General Liability policy shall contain a Non-Waiver of Governmental Immunities endorsement containing the following language:

Non-Waiver of Governmental Immunity:

We, the insurance carrier and insured, expressly agree and state that the purchase of this policy and the naming of Polk County, Iowa as an additional insured does not waive any of the defenses of governmental immunity available to Polk County pursuant to Section 670.4 of the Iowa Code, as it now exists and as it may be amended from time to time.

We, the insurance carrier and insured, further agree that this policy shall cover only those claims not subject to the defense of governmental immunity under the Code of Iowa Section 670.4 as it now exists and as it may be amended from time to time.

We, the insurance carrier and insured, shall not deny coverage under this policy and we shall not deny any of the rights and benefits accruing to Polk County, Iowa for reasons of governmental immunity unless and until a court competent jurisdiction has ruled in favor of the defense(s) of governmental immunity asserted by Polk County.

3. Automobile Liability:

Combined Single Limit: $1,000,000

This insurance shall cover all vehicles used by Contractor whether they are owned, non-owned, or hired. Waiver of subrogation applies in favor of Polk County, Iowa.

4. Excess Liability/ Umbrella:

Excess/Umbrella coverage should extend over the underlying General Liability, Auto Liability, and Employers’ Liability coverage.

The type of work or service being provided under this agreement will determine the required Excess Liability/ Umbrella limit. The line item checked below indicates the required limit:

____ $1,000,000

____ $2,000,000

____ $5,000,000

The total required limits may be achieved by any combination of underlying and Excess coverage.

ADDITIONAL INSURANCE REQUIREMENTS

If the product or service to be provided presents additional exposures not contemplated by the minimum insurance requirements listed above, the following additional insurance coverages may be required. A checked line item indicates Contractor must provide the additional coverage.

____ Professional Liability (Errors & Omissions):

____ $1,000,000 limit ____ $2,000,000 limit

Required when professional services are rendered. If coverage is written on a “claims-made” basis, coverage must remain in force for at least three years after project is complete.

____ Performance Bond: Limit = 100% of the total contract amount.

Required for various construction projects.

____ Builder’s Risk: Limit = 100% of the replacement cost of proposed construction.

Required for various construction projects.

____ Cyber Liability: $1,000,000 limit Required for Contractors accessing or interfacing with Polk County’s IT system.

____ Liquor Liability: $1,000,000 limit.

Required if Contractor will be serving alcohol.

MISCELLANEOUS

1. Cost of Insurance. The cost of providing any required insurance coverage is the responsibility of the Contractor. Polk County shall make no direct payments to the Contractor for any costs associated with the purchase of any insurance coverage.

2. Personal Liability of Public Officials. In carrying out any of the provisions of the contract Agreement, or in exercising any power or authority granted to any agent or representative of Polk County thereby, there shall be no liability upon such agent or representative, including the engineer or authorized assistants, in either their personal capacity or in their official capacity as an official of Polk County. Said agents or representatives shall only be understood and considered to act in such matters as the agent and representative of the contracting authority and governmental entity and political subdivision of the State of Iowa, Polk County, Iowa.

3. Non-Waiver of Legal Rights. Polk County, Iowa shall not be precluded or estopped by any measurement, estimate, or certificate made either before or after the completion and acceptance of the work and payment thereof, from showing the true amount and character of the work performed and the materials furnished by the Contractor, or from showing that such measurement, estimate, or certificate is untrue or incorrectly made or that the work or materials do not in fact conform to the Terms of the contract Agreement.

Polk County, Iowa shall not be precluded or estopped, notwithstanding any such measurement, estimate, or certificate and payment in accordance therewith, from recovering from the Contractor and Surety such damages as it may sustain by reason of failure to comply with the Terms of the contract Agreement. Neither the acceptance by Polk County, Iowa, nor any agent or representative(s), nor payment for acceptance of the whole or any part of the work, nor any extent of time, nor any possession taken place by Polk County, Iowa shall operate as a waiver of any portion of the contract Agreement, or any powers herein reserved, or any right to damages herein provided. A waiver of any breach of the contract Agreement shall not be held to be a waiver of any other subsequent breach.

4. Waiver of Subrogation. The Contractor hereby releases Polk County, Iowa, its elected and appointed officials, directors, employees, volunteers, agents and assigns from and against any and all liability or responsibility to Contractor or anyone claiming through or under the Contractor by way of subrogation or otherwise, for any loss without regard to the fault of Polk County or the type of loss involved, including loss due to occupational injury.

5. OSHA Compliance. The Contractor is required to and shall be in compliance with all OSHA safety guidelines and regulations at all times during the term and duration of this agreement.

6. Certificates of Insurance. The Contractor shall provide Polk County with a Certificate of Insurance evidencing the required insurance coverage herein, utilizing the current ACORD form. The Certificate shall be submitted with each set of contract documents.

Contract documents shall not be submitted to the Board of Supervisors for approval or execution until the Certificate of Insurance has been received, reviewed, and approved by Polk County staff. Please note:

Certificate should be sent to: Polk County, Iowa Attention: Risk Management 111 Court Avenue, Suite 372 Des Moines, IA 50309

The project name and work order number should be clearly noted in the “description” section of the Certificate.

A copy of the Non-Waiver of Governmental Immunities endorsement should be attached to the Certificate.

A properly completed sample certificate is provided for reference, showing the minimum insurance requirements with attached Non-Waiver of Governmental Immunities endorsement. Your specific insurance requirements may vary as outlined in this document.

See attached “Sample”

(Revised 03/01/2024)

01/1/2024

ABC Insurance Agency 987 Pine Lane Anytown, IA

IA 50309

DEF Contractors, Inc, 456 SW 1st Street Anyplace, IA

XYZ Company

A Policy #

1,000,000 100,000 5,000 1,000,000 2,000,000 2,000,000

A Policy #

1,000,000

Policy # 1,000,000

A N Policy # 500,000 500,000 500,000

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

INSURER(S) AFFORDING COVERAGE

INSURER F :

INSURER E :

INSURER D :

INSURER C :

INSURER B :

INSURER A :

NAIC #

NAME:

CONTACT

(A/C, No):

FAX

E-MAIL

ADDRESS:

PRODUCER

(A/C, No, Ext):

PHONE

INSURED

REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES

IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.

If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).

THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED

REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

OTHER:

(Per accident)

(Ea accident)

N / A

SUBR

WVD

ADDL

INSD

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

$PROPERTY DAMAGE

BODILY INJURY (Per accident)

BODILY INJURY (Per person)

COMBINED SINGLE LIMIT

AUTOS ONLY

AUTOSAUTOS ONLY

NON-OWNED

SCHEDULEDOWNED

ANY AUTO

AUTOMOBILE LIABILITY

Y / N

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH)

DESCRIPTION OF OPERATIONS below If yes, describe under

ANY PROPRIETOR/PARTNER/EXECUTIVE

E.L. DISEASE - POLICY LIMIT

E.L. DISEASE - EA EMPLOYEE

E.L. EACH ACCIDENT

ER

OTH-

STATUTE

PER

LIMITS(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY)

POLICY EFF

POLICY NUMBERTYPE OF INSURANCELTR

INSR

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

EXCESS LIAB

UMBRELLA LIAB $EACH OCCURRENCE

$AGGREGATE

OCCUR

CLAIMS-MADE

DED RETENTION $

$PRODUCTS - COMP/OP AGG

$GENERAL AGGREGATE

$PERSONAL & ADV INJURY

$MED EXP (Any one person)

$EACH OCCURRENCE

DAMAGE TO RENTED

$PREMISES (Ea occurrence)

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR

GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY

PRO-

JECT LOC

CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)

CANCELLATION

AUTHORIZED REPRESENTATIVE

ACORD 25 (2016/03)

© 1988-2015 ACORD CORPORATION. All rights reserved.

CERTIFICATE HOLDER

The ACORD name and logo are registered marks of ACORD

HIRED

AUTOS ONLY

Joe Agent (xxx)XXX-XXXX joe_agent@abcagency.com

01/01/2024 01/01/2025

01/01/2024 01/01/2025

01/01/2024 01/01/2025

Y Y

Y

Y

1,000,000

RE: Project Falcon, Work Order #12345

Polk County, Iowa 111 Court Ave Des Moines, IA 50309

Must be signed

01/01/2024 01/01/2025

A

12345

Sam ple

Sam ple

Sam ple

Sam ple

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Janelle Friedman Typewriter Polk County, Iowa, its elected and appointed officials, employees, agents, their predecessors, successors, and asigns