Attachment12-InsuranceCertification.docx

California Department of Aging RFP Number: RFP-2526-01 Aging Resource Directory

ATTACHMENT 12

Insurance Certifications Proposer’s Name: ____________________________________________________________ This form reminds proposers of the insurance requirements that may be imposed by this solicitation and provides samples of some of the forms that they may be required to produce prior to being awarded an agreement.

Proposer acknowledges that they have reviewed and understand the insurance requirements for this solicitation as described in Attachment 18, Sample Agreement, Exhibit E, Insurance Requirements.

Proposer acknowledges that they have reviewed and understand the sample insurance forms provided with this attachment.

Proposer certifies that, if awarded an agreement, the proposer shall provide CDA with all required insurance documents as may be applicable, in a timely manner. This includes, but may not be limited to:

Certificates of insurance showing the proposer’s insurance coverage types and limitations.

Proof that the proposer has insured the State of California, its officers, employees, and agents. Proposer further understands that this proof shall come in the form of either:

1. An endorsement to the proposer’s insurance policy (Form CG 20 10 11 85 or as broad as),

2. A copy of the proposer’s current insurance policy that shows that the policy already insures all parties required to be insured by this Agreement.

Proposer certifies that, should Commercial General Liability insurance be required, and should the proposer use a subcontractor to complete a portion of this Agreement, the proposer shall either:

1. Include the subcontractor as an additional named insured under the proposer’s policy, or

2. Ensure that each subcontractor is insured under their own Commercial General Liability policy.

Proposer acknowledges that they understand that CDA reserves the right, at its sole discretion, to cancel a proposed award to a proposer who does not submit the required documentation described herein.

Proposers are reminded that there is no requirement to submit proof of insurance with their proposal. Proof of insurance shall only be required of those firm(s) awarded a contract.

ENDORSEMENT

Language on this certificate indicating that the State is an additional insured is not sufficient to meet the requirements of Exhibit E.

INSURED

The name in this box MUST match the name listed in the PAYEE’S LEGAL BUSINESS NAME field on the Std. 204.

TYPE OF INSURANCE and LIMITS Each required insurance type, with the exception of Worker’s Compensation and Professional Liability, must be listed on the certificate.

POLICY EXP.

All required insurance types must be active (not expired). If an insurance policy expiration date is impending, awarded firms are advised to be ready to submit an updated certificate with the renewal dates.

CERTIFICATE HOLDER

This box must be completed as indicated in Exhibit E, section 4.

ACORD CERTIFICATE

This is a sample insurance certificate.

ADDITIONAL INSURED LANGUAGE

As required in Exhibit E, the “State of California, its officers, employees, and agents” must be listed as the additional insured parties. However, this endorsement may be limited to just the operations under the Agreement.

POLICY OR FORM NUMBER

A blanket endorsement such as this MUST be reconcilable to the insurance certificate. To ensure that they are reconcilable, ensure that the blanket endorsement contains either the policy number or a form number that is also clearly referenced on the insurance certificate.

ADDITIONAL INSURED LANGUAGE

As required in Exhibit E, the “State of California, its officers, employees, and agents” must be listed as the additional insured parties. However, this endorsement may be limited to just the operations under the Agreement.

POLICY OR FORM NUMBER

Like a blanket endorsement, this traditional endorsement must be reconcilable to the insurance certificate. A policy or form number that is also referenced on the insurance certificate must be present on the endorsement.

POLICY OR FORM NUMBER

Like a blanket endorsement, this traditional endorsement must be reconcilable to the insurance certificate. A policy or form number that is also referenced on the insurance certificate must be present on the endorsement.

TRADITIONAL ENDORSEMENT

This is an example of an endorsement amending an insurance policy to add the state as an additional insured.

image1.png image2.png