Attachment F - Bid Quotation Form 1.pdf

180 KB Posted

Attached to
KYTC Workers Comp Excess Insurance
Solicitation number
RFB 758 2200000059 3
Issued by
Elliott County, Kentucky

About this file

Written by GovTribe AI ·

This is a Bid Quotation Form for Excess Workers' Compensation Insurance issued by the Kentucky Transportation Cabinet through a competitive bidding process in accordance with KRS 45A. The desired coverage includes Excess Workers' Compensation Insurance with a policy period running from 12:01 a.m. on August 24, 2021 through 12:01 a.m. on August 24, 2022. The contract term is one year, covering the specified 12-month period.

The insurance limits required are $10,000,000 per accident for Excess Workers' Compensation Coverage, $1,000,000 per accident for Employers' Liability Coverage, and a Self-Insured Retention of $1,000,000 per accident. Bidders must submit their annual premium quote on this form, along with the name of the insurance agency, the name of the insurer, and authorization signatures from an agency representative including title and telephone contact information.

View the file

Other files

File Type Posted
Attachment B - Annual Affidavit and Other Affidavits.pdf PDF
Attachment A - RFB 758 2200000059-1 07-28-2021.pdf PDF
Attachment I - Vehicle Supplemental Application.pdf PDF
Attachment K - Watercraft Supplemental Application.pdf PDF
Attachment D - Detailed Requirements.pdf PDF
Attachment Q - EXHIBIT G-Claim Reserves (Total Incurred) - 2021.xlsx XLSX spreadsheet
Attachment G - Bid Specifications Deviation Form 1A.pdf PDF
Attachment M - Employee Concentration Supplemental Info.pdf PDF
Attachment L - Aircraft Supplemental Application.pdf PDF
Attachment C - How to Respond to an Online Bid through the Kentucky Vendor Self Service site.pdf PDF
Attachment O - WC Temporary Modified Duty Plan - GAP 303-2.pdf PDF
Attachment E - Bidder Information Sheet.pdf PDF
Final_RFB_758_2200000059_1_SO_FORM.PDF PDF
Attachment H - Bid Specification Enhancement Form 1B.pdf PDF
Attachment A - RFB 758 2200000059-2 07-29-2021.pdf PDF
Attachment J - Risk Management Supplemental Form.pdf PDF
Attachment N - EXHIBIT C-KYTC Loss Run 8-15-06 - 5-31-21.xlsx XLSX spreadsheet
Final_RFB_758_2200000059_2_SO_FORM.PDF PDF
Attachment P - KYTC Jobs PPE 6-15-21 - WC codes.xlsx XLSX spreadsheet
Show all 19

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file
Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

BIDDER INFORMATION SHEET

EXCESS WORKERS' COMPENSATION INSURANCE

COMMONWEALTH OF KENTUCKY

KENTUCKY TRANSPORTATION CABINET

THROUGH A COMPETITIVE BIDDING PROCESS

IN ACCORDANCE WITH KRS 45A

BID QUOTATION FORM 1

Invitation No. _____________________ Date:________________________________________

DESIRED COVERAGE

Excess Workers’ Compensation Insurance

POLICY PERIOD

12:01 a.m. August 24, 2021 to 12:01 a.m. August 24, 2022

LIMIT OF INSURANCE

Excess Workers’ Compensation Coverage: $10,000,000 per accident

Employers’ Liability Coverage: $1,000,000 per accident

Self-Insured Retention: $1,000,000 per accident

Annual Premium: $___________________

(Name of Insurance Agency) (Name of Insurer)

(Signature of Agency Authorized Rep) (Date)

(Agency Authorized Rep – Print Name) (Title) (Telephone)

File details come from the government source that posted it. Updated .