Attachment F - Bid Quotation Form 1.pdf

This is a Bid Quotation Form for Public Officials Liability Insurance issued by the Commonwealth of Kentucky, Kentucky Workers' Compensation Funding Commission, under a competitive bidding process governed by KRS Chapter 45A. The Commonwealth seeks Public Officials Liability coverage and Employment Practices Liability coverage on a claims-made basis for the named insured. The policy period runs from 12:01 a.m. on December 31, 2021, through 12:01 a.m. on December 31, 2022, with full prior acts coverage applying to all insuring agreements via a retroactive date provision. The desired limit of insurance is $1,000,000 per claim, with separate $25,000 deductibles applicable to both Public Officials Liability claims and Employment Practices Liability claims.

Bidders must provide pricing that includes a Kentucky Surcharge of 1.8% in addition to the base premium, with all costs reflected in a total premium line item. The form requires submission by authorized representatives of both the insurance agency and the insurer, including signatures, printed names, titles, and telephone contact information. This quotation form establishes the framework for competitive bids to determine the most cost-effective coverage for the Commonwealth's public officials liability insurance needs during the specified twelve-month policy period.