Insurance_(2).docx
DOCX document 55 KB Posted
- Attached to
- 31-2102 Counters
- Solicitation number
- 31-2102 Counters
- Issued by
- Kittitas County, Washington
About this file
The document is an Exhibit C detailing insurance coverage requirements for Lewis County, Washington, specifically for a project involving the installation of solid surface countertops at the new Community Development Building. The insurance requirements outline comprehensive coverage specifications including general liability, automobile liability, excess liability, workers' compensation, and professional liability insurance with specific monetary limits for each category, ranging from $1,000,000 to $2,000,000 per occurrence and in aggregate.
The insurance documentation mandates that the contractor's insurance company provide a certificate of insurance demonstrating the required coverage, with Lewis County named as an additional insured. The certificate must include provisions for 45-day written notice in the event of policy cancellation, as per Washington state law (RCW 48.18.290). The insurance requirements are part of a procurement process for a countertop installation project, with the insurance specifications designed to protect Lewis County's interests by ensuring comprehensive risk mitigation through robust insurance coverage across multiple liability domains.
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Other files
| File | Type | Posted |
|---|---|---|
| 31-2102_Counters.pdf | ||
| J2037C__LCDP__Rainer_Bldg_A-floorplan.pdf | ||
| CommDev_Reception_Desk.pdf |
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Text version
EXHIBIT C -- INSURANCE COVERAGE REQUIREMENTS
INDICATES WHAT TYPE OF INSURANCE IS REQUIRED
TYPE OF INSURANCE
LIMITS OF LIABILITY
| Each Occurrence |
| Aggregate |
GENERAL LIABILITY
| Comprehensive Form |
| Bodily Injury |
| $1,000,000 |
| $2,000,000 |
| Premises - Operations |
| Property Damage |
| $1,000,000 |
| $2,000,000 |
Explosion & Collapse Hazard
Underground Hazard
OR
Products/Completed Operations Hazard
| Contractual Insurance |
| Bodily Injury and Property Damage Combined Single Limit |
| $1,000,000 |
| $2,000,000 |
Broad Form Property Damage, Incl. Care, Custody Control
Independent Contractors
| Personal Injury |
| Personal Injury |
| $1,000,000 |
| $2,000,000 |
AUTOMOBILE LIABILITY
| Comprehensive Form |
| Bodily Injury (Each Person) |
| $1,000,000 |
| Owned |
| Bodily Injury (Each Accident) |
| $1,000,000 |
| Hired |
| Property Damage OR |
| $1,000,000 |
| Non-Owned |
| Bodily Injury & Property Damage |
Combined Single Limit $1,000,000
EXCESS LIABILITY (Over and above automobile and general liability
| Umbrella Form |
| Bodily Injury/Property Damage Combined |
| $1,000,000 |
OR
$1,000,000
Excess Liability Gap Layer
| $1,000,000 |
| $1,000,000 |
| WORKER'S COMPENSATION and |
| Statutory |
EMPLOYER LIABILITY
$1,000,000
OTHER
| Builder's All Risk | |
| Amount of Contract Price | |
| $________________ |
| Errors & Omissions (Professional Liability) |
| $1,000,000 $2,000,000 |
| Please indicate: Claims-Made Form:______________, Occurrence Form:____________, |
| Extending Reporting Provisions Avail. ____________ |
The Contractor's insurance company must provide a certificate of insurance on acceptable form showing the above required coverage and modified to conform to the following endorsement. The following endorsement must also be signed by the insurer.
FORM
12.16.03
CS-FACIL
LEWIS COUNTY, WA
CERTIFICATE OF INSURANCE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
| INSURED (Legal name and business address) |
| CERTIFICATE HOLDER: |
LEWIS COUNTY, WASHINGTON
DEPT. OF CENTRAL SERVICES
CONTRACT NUMBER
| LEWIS COUNTY HISTORICAL COURTHOUSE |
| DATE ISSUED: |
351 N. W. NORTH STREET
CHEHALIS, WASHINGTON 98532
PROJECT DESCRIPTION / LOCATIONS / VEHICLES / RESTRICTIONS / SPECIAL ITEMS:
This is to certify that policies of Insurance listed below have been issued to the Insured named above for the policy period indicated.
CO
LTR
| TYPE OF INSURANCE |
| POLICY NUMBER |
| Date Policy Effective |
(MM/DD/YY)
Date Policy Expires
(MM/DD/YY)
ALL LIMITS IN THOUSANDS
GENERAL LIABILITY
| General Aggregate |
| $ |
Commercial General Liability
| Products Comp/Ops Aggregate |
| $ |
Claims Made
Occurrence
| Personal & Advertising Injury |
| $ |
Owner’s & Contractors Protection
| Each Occurrence |
| $ |
| Fire Damage (Any One Fire) |
| $ |
Deductible $
| Medical Expense (Any One Person) |
| $ |
AUTOMOBILE LIABILITY
| CSL |
| $ |
Any Auto
All Owned Autos
| Bodily Injury (per person) |
| $ |
Scheduled Autos
Hired Autos
| Bodily Injury (per accident) |
| $ |
Non-Owned Autos
Garage Liability
| Property Damage |
| $ |
Deductible $
EXCESS LIABILITY
Each Occurrence
Aggregate
Other Than Umbrella Form
WORKERS COMPENSATION
AND
EMPLOYER’S LIABILITY
STATUTORY
$ (Each Accident)
$ (Disease Policy Limit)
$ (Disease-Each Employee)
OTHER
ADDITIONAL PROVISIONS
LEWIS COUNTY is included as additional insured as related to the above-mentioned project.
Should any of the above described policies be cancelled before the expiration date thereof, the issuing Company must deliver or mail not less than 45 days written notice to the above Certificate Holder, per RCW 48.18.290
| COMPANIES AFFORDING COVERAGE |
| ISSUING COMPANY, AGENT OR REPRESENTATIVE |
| NOTE: | Attach a separate sheet to this certificate giving |
| all the company names and their percentage of coverage, if | clarification is needed, |
NAME:
ADDRESS:
Company Letter Authorized Signature
Title
Signature Date
Signee Name
Telephone No.
A
B
C
D
E image1.png
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