Attachment H - Business Automobile Liability Insurance Attestation.pdf
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- Solicitation number
- 2140589
- Issued by
- New York
About this file
This is a Business Automobile Liability Insurance Attestation document issued by the New York State Department of Labor (NYSDOL) for contractors responding to a solicitation. The attestation form requires bidders to certify their current vehicle ownership, leasing, or hiring status and their corresponding Business Automobile Liability Insurance coverage under the requirements specified in Appendix GTC, General Terms and Conditions, Section 2.7.C. Contractors must select one of two options: either certifying that they do not currently own, lease, or hire vehicles for contract fulfillment, or certifying that they hire and/or utilize non-owned vehicles but do not currently possess all required insurance. The document establishes submission procedures requiring a signed electronic copy via email to DOLPurchase.Contracts@labor.ny.gov and an original hard copy sent to the NYS Department of Labor Purchase and Contracts office in Albany.
For contractors selecting the second option regarding hired or non-owned vehicles, Business Automobile Liability Insurance with limits of not less than $1,000,000 per accident, or as required by law whichever is greater, must be obtained and maintained at the contractor's expense. If a contractor acquires or leases vehicles during the contract term, proof of updated insurance must be provided within ten business days in the form of a certificate of coverage, along with all applicable endorsements including additional insured provisions. Failure to obtain or maintain required insurance constitutes a breach or default of the contract, and contractors remain held accountable for all obligations and liabilities regardless of insurance status. All proof of coverage and endorsements must be submitted to the NYS Department of Labor, Purchase and Contracts, at the Albany office location.
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Attachment H - Business Automobile Liability Insurance Attestation
In the event that your firm does not currently possess all Business Automobile Liability Insurance as required by Appendix GTC, General Terms and Conditions, Section 2.7.C, your firm will be required to complete the attached attestation and this attestation must be signed by an individual who is authorized to bind the organization in a contract.
Please return a signed, electronic copy via email to DOLPurchase.Contracts@labor.ny.gov with an original hard copy of the attestation, signed in black or blue ink, to follow addressed to:
NYS Department of Labor Purchase and Contracts
Harriman State Office Campus Building 12, Room 465
Albany, NY 12226
New York State Department of Labor Business Automobile Liability Insurance Attestation
To comply with the Business Automobile Liability Insurance Requirements outlined in Section 2.7.C of Appendix GTC, General Terms and Conditions, of the Solicitation issued by the New York State Department of Labor (NYSDOL), I hereby certify that ( please check one option below):
The undersigned organization does not currently own, lease, or hire any vehicles which will be used to fulfill the requirements of any contract resulting from the above referenced solicitation;
Based upon the foregoing, the undersigned organization does not currently possess Business Automobile Liability Insurance as required by Appendix GTC, General Terms and Conditions, Section 2.7.C;
If, during the term of any contract resulting from the above referenced solicitation, the undersigned organization acquires, leases, or hires a vehicle or vehicles that will be used to fulfill the requirements of any contract resulting from the above referenced solicitation, the undersigned organization will obtain Business Automobile Liability Insurance that meets all of the requirements set forth in the above referenced solicitation and provide DOL with evidence of such coverage in the form of a certificate within ten (10) business days following the date the Business Automobile Liability Insurance coverage is bound. Subsequently, the undersigned organization will provide DOL with copies of all applicable endorsements (i.e. an additional insured endorsement) upon receipt. Proof of coverage and applicable endorsements shall be submitted to: The New York State Department of Labor; Purchase and Contracts; State Office Campus, Building 12, Room 465; Albany, NY 12226.
The undersigned organization understands that a failure to provide or maintain any insurance required by above referenced solicitation or any contract resulting from that solicitation after the undersigned organization acquires, leases, or hires a vehicle or vehicles that will be used to fulfill the requirements of any contract resulting from the above referenced solicitation shall be treated as a breach or default under that contract and the undersigned organization shall still be held accountable for any obligations, responsibilities or liabilities under the above referenced solicitation or any contract resulting from that solicitation.
The undersigned organization does not currently own or lease any vehicles which will be used to fulfill the requirements of any contract resulting from the above referenced solicitation, however the organization does hire and/or utilize non-owned vehicles to fulfill the requirements of any contract resulting from the above referenced solicitation;
Based upon the foregoing, the undersigned organization does not currently possess all Business Automobile Liability Insurance as required by Appendix GTC, General Terms and Conditions, Section 2.7.C;
Based on the selection of this option, the undersigned organization must obtain and maintain in full force and effect, at their own expense, the following insurance with limits not less than $1,000,000 for each accident, or as required by law, whichever is greater (limits may be provided through a combination of primary and umbrella/excess policies).
Such insurance shall cover liability arising out of hired and/or non-owned automobiles.
If, during the term of any contract resulting from the above referenced solicitation, the undersigned organization acquires or leases a vehicle or vehicles that will be used to fulfill the requirements of any contract resulting from the above referenced solicitation, the undersigned organization will obtain Business Automobile Liability Insurance that meets all of the requirements set forth in the above referenced solicitation and provide DOL with evidence of such coverage in the form of a certificate within ten (10) business days following the date the Business Automobile Liability Insurance coverage is bound. Subsequently, the undersigned organization will provide DOL with copies of all applicable endorsements (i.e. an additional insured endorsement) upon receipt. Proof of coverage and applicable endorsements shall be submitted to: The New York State Department of Labor; Purchase and Contracts; State Office Campus, Building 12, Room 465; Albany, NY 12226.
The undersigned organization understands that a failure to provide or maintain any insurance required by above referenced solicitation or any contract resulting from that solicitation after the undersigned organization acquires or leases a vehicle or vehicles that will be used to fulfill the requirements of any contract resulting from the above referenced solicitation shall be treated as a breach or default under that contract and the undersigned organization shall still be held accountable for any obligations, responsibilities or liabilities under the above referenced solicitation or any contract resulting from that solicitation.
New York State Department of Labor Business Automobile Liability Insurance Attestation
Signature Block
Signature of Organization Official:
Print/type Name
Title:
Organization:
Date Signed:
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