Attachment F - Bid Quotation Form 1 - RFB 758 2300000459.pdf

110 KB Posted

Attached to
KDVA Directors & Officers Liability Insurance
Solicitation number
RFB-758-2300000459-3
Issued by
Hardin County, Kentucky

About this file

Written by GovTribe AI ·

This document is an Attachment F - Bid Quotation Form 1 related to Request for Bid (RFB) 758 2300000459 for KDVA Directors & Officers Liability Insurance. The requested coverage is for Directors & Officers Liability/Employment Practices Liability on a claims made basis, with a policy period of March 31, 2023 to March 31, 2024. Bidders are required to provide quotes for a $2,000,000 limit per claim and $2,000,000 general aggregate, with a nil deductible for each Directors & Officers and Employment Practices claim. The total premium, including applicable taxes, must be provided.

The bid quotation form requires the name of the insurance agency, insurer, authorized representative, their title, and contact telephone number. There is also a restriction on communications clause included in the document.

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Other files

File Type Posted
Attachment D - Detailed Requirements - RFB 758 2300000459.pdf PDF
Attachment E - Bidder Information Sheet - RFB 758 2300000459.pdf PDF
Attachment B - Annual Affidavit and Other Affidavits - REVISED 01-17-2023.pdf PDF
Final_RFB_758_2300000459_1_SO_FORM.PDF PDF
Attachment A - RFB 758 2300000459-1 - 01-25-2023.pdf PDF
Attachment K - KDVA-OKVC FY22 Income Statement.xlsx XLSX spreadsheet
Attachment I - DO FY23 List of Individuals.xlsx XLSX spreadsheet
Final_RFB_758_2300000459_2_SO_FORM.PDF PDF
Attachment J - FY23 Medical Malpractice Insurance Coverage List.xlsx XLSX spreadsheet
Attachment A - RFB 758 2300000459-2 - 02-26-2023.pdf PDF
Attachment G - Bid Specifications Deviation Form 1A - RFB 758 2300000459.pdf PDF
Final_RFB_758_2300000459_3_SO_FORM.PDF PDF
Attachment C - How to Respond to an Online Bid through the Kentucky Vendor Self Service site.pdf PDF
Attachment A - RFB 758 2300000459-3 - 02-8-2023.pdf PDF
Attachment L - KDVA OKVC FY23 Balance Sheet.xlsx XLSX spreadsheet
Attachment H - Bid Specification Enhancement Form 1B - RFB 758 2300000459.pdf PDF
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RFB 758 2300000459

ATTACHMENT F – BID QUOTATION FORM 1

KDVA DIRECTORS & OFFICERS LIABILITY INSURANCE

BID QUOTATION FORM 1

Invitation No. _____________________ Date:________________________________________

DESIRED COVERAGE

Directors & Officers Liability/Employment Practices Liability Insured on a claims made basis for the named insured.

POLICY PERIOD

12:01 a.m. March 31, 2023 to 12:01 a.m. March 31, 2024

LIMIT OF INSURANCE

Provide bids on the following limits:

$2,000,000 each claim $________________ $2,000,000 general aggregate Nil deductible for each Directors & Officers claim $________________ Nil deductible for each Employment Practices claim

TAXES

1.8% Kentucky Surcharge $________________

3% Surplus Lines Tax (if applicable) $________________

TOTAL PREMIUM (INCLUDING TAX) $________________

(Name of Insurance Agency) (Name of Insurer)

(Signature of Agency Authorized Rep) (Date)

(Agency Authorized Rep – Print Name)

(Title) (Telephone)

RESTRICTION ON COMMUNICATIONS

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