Attachment H - Business Automobile Liability Insurance Attestation8.pdf

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 2.6.B.2, 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 12240

New York State Department of Labor Business Automobile Liability Insurance Attestation

To comply with the Business Automobile Liability Insurance Requirements outlined in Section 2.6.B.2 of Appendix GTC, General Terms and Conditions, of the Solicitation RFP #Z-xx 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 2.6.B.2;

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 12240.

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 2.6.B.2;

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 12240.

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: