INSURANCE REQUIREMENTS

Awarded Contractors will be required to maintain the following insurance coverage during the term of the

Contract:

1. Workers’ compensation and disability benefits insurance coverage as required under New York State law. Proof of workers’ compensation insurance and disability benefits insurance must be provided with the proposal. If applicant is legally exempt from such coverage, proof of exemption must be provided.

The only forms acceptable as evidence of these insurance requirements are:

Proof of Workers’ Compensation Coverage

• Form C-105.2 - Certificate of Workers’ Compensation Insurance issued by private insurance carriers; or

• Form U-26.3 issued by the State Insurance Fund; or

• Form SI-12 - Certificate of Workers’ Compensation Self-Insurance; or

• Form GSI-105.2 - Certificate of Participation in Workers’ Compensation Group Self-

Insurance; or

• Form CE-200 - Certificate of Attestation of Exemption from New York State Workers’

Compensation and/or Disability Benefits Coverage.

Proof of Disability Benefits Coverage

• Form DB-120.1 - Certificate of Disability Benefits Insurance, or

• Form DB-120.2 - Certificate of Participation in Disability Benefits Group Self-Insurance; or

• Form DB-155 - Certificate of Disability Benefits Self-Insurance; or

• Form CE-200 - Certificate of Attestation of Exemption from New York State Workers’

Compensation and/or Disability Benefits Coverage.

Please note that an ACORD Certificate of Insurance is NOT acceptable proof of New York State workers’ compensation or disability benefits insurance coverage. Applicants should obtain the appropriate Workers’

Compensation Board forms from their insurance carrier or licensed agent, or follow the procedures set forth by the Workers’ Compensation Board for obtaining an exemption from coverage. Required forms and procedures may be obtained on the Workers’ Compensation Board website at www.wcb.ny.gov/ and click on ‘Employers/Businesses’ and/or ‘Forms.’ Any questions regarding workers’ compensation coverage requirements should be directed to:

Workers’ Compensation Board

Bureau of Compliance

(518) 462-8882

(866) 298-7830

Applicants awarded funding (whether through a new or amended contract) will be required to provide updated certificates of workers’ compensation and disability benefits coverage that name the UCS as the certificate holder if the applicable form has a space for a certificate holder to be listed. The carrier must enter:

NYS Unified Court System

Office of Court Administration

Division of Grants, Contracts & Procurement

2500 Pond View, Suite 104

Castleton-on-Hudson, New York 12033

The insurance carrier must notify the certificate holder if a policy is canceled.

2. Commercial General Liability Insurance (bodily injury and property damage on an occurrence basis), personal injury and advertising liability coverage, contractual and products/completed operations liability coverage, and auto liability with minimum limits as follows:

Bodily Injury and Property Damage $1 million per occurrence, $2 million aggregate

Personal Injury and Advertising $1 million aggregate

Contractual and Products/ Completed Operations

Liability

$2 million aggregate

Auto Liability, Combined single limits $1 million

Commercial general liability insurance coverage must be obtained from commercial insurance carriers licensed in, or otherwise authorized to do business in, the State of New York. Proof of applicant’s commercial general liability insurance coverage must be submitted with the proposal. Applicants awarded funding will be required to submit an updated certificate that meets the requirements outlined below under

“Insurance Compliance” prior to finalization of the contract. The commercial general insurance of

Applicants awarded funding shall be primary insurance with respect to UCS.

Products completed operations insurance coverage is not required if applicant provides written documentation prior to finalization of an awarded contract that the organization’s commercial general insurance policy does not include coverage for products-completed operations. Automobile liability insurance is not required if applicant does not use vehicles in its operations.

3. Commercial or other Property Insurance (hazard and casualty) coverage must be obtained from commercial insurance carriers licensed or otherwise authorized to do business in the State of New York.

Proof of applicant’s commercial property insurance coverage must be submitted with the proposal.

Applicants awarded funding will be required to submit an updated certificate prior to finalization of the contract. Such insurance must meet the requirements below under “Insurance Compliance” and shall cover the premises owned or rented by the vendor in an amount not less than the full insurable value

(replacement value) of the real property unless otherwise approved in writing by UCS. The certificate must name UCS as an additional insured and loss payee.

4. Professional liability insurance in the amount of $1,000,000 per claim ($3 million aggregate) for all of applicant’s professional employees that will perform with grant funding. Proof of applicant’s professional liability insurance coverage must be submitted with the proposal. Organizations awarded funding will be required to contractually agree to obtain tail coverage for a minimum of two years in the event that the organization’s professional liability coverage policy is terminated and either: (i) there is no replacement policy; or (ii) the replacement policy does not cover claims made against the organization based on events that occurred prior to the effective date of the new policy.

5. Insurance Compliance:

All policies shall be written with insurance companies licensed to do business or authorized by the New

York State Department of Financial Services to issue insurance in the State of New York and be rated no lower than an A- rating Class VII or better in the most current edition of A.M. Best’s Property-Casualty

Key Rating Guide. UCS may, in its sole discretion, accept policies of insurance written by a non-authorized carrier or carriers when certificate or other policy documents are accompanied by a completed Excess Lines Association of New York (ELANY) affidavit or other document demonstrating the company’s strong financial rating.

Policies should be endorsed to the New York State Unified Court System as an “additional insured” or

“loss payee,” as appropriate, and “certificate holder.” All policies shall allow waiver of subrogation in favor of UCS and indemnified parties and additional insureds. All policies must be endorsed to provide that in the event of cancellation, non-renewal or material modification UCS will receive thirty (30) days’ prior written notice thereof. Awarded Contractor must provide UCS with appropriate certificates of insurance in compliance with these requirements no later than five business days prior to commencement of the Contract. Awarded Contractor must furnish complete policies, including all endorsements thereto, to UCS upon request. By requiring insurance, UCS does not represent that certain coverage and limits will necessarily be sufficient to protect Awarded Contractor, and such coverage and limits shall not be deemed a limitation on Awarded Contractor’s liabilities under any indemnity granted to UCS under the Contract. Prior to the commencement of any work by a subcontractor, the Awarded

Contractor shall require such subcontractor to procure policies of insurance as required herein and maintain the same in force during the terms of any work performed by that subcontractor.