Insurance_Requirements_and_Transmittal.doc

INSURANCE REQUIREMENTS AND TRANSMITTAL FORM

CITY PURCHASING

REF:

City of Seattle

Attachment This Insurance Requirements and Transmittal Form shall serve as an attachment and/or exhibit form to the (“Contract”), and shall be interpreted and applied together as a single contractual instrument between the City of Seattle (“City”) and (“Vendor”).

VENDOR: SEND THIS FORM TO YOUR INSURANCE PROFESSIONAL TO COMPLETE THE GREEN BOX AND TO ENSURE COMPLIANCE WITH ALL THE COVERAGE REQUIREMENTS, TERMS AND CONDITIONS REQUIRED BY THE CITY OF SEATTLE.

INSURANCE AGENT/BROKER:

( PLEASE COMPLETE THESE FIELDS SO THAT WE MAY CONTACT YOU IF NECESSARY. *REQUIRED FIELDS

*NAME:

TITLE:

*NAME OF COMPANY

*EMAIL:

*TELEPHONE:

FAX:

( SEND ORIGINAL CERTIFICATION WITH COPY OF CGL ADDITIONAL INSURED ENDORSEMENT OR BLANKET ADDITIONAL INSURED POLICY WORDING and applicable endorsements that evidences the coverage required TO:

THE CITY OF SEATTLE PURCHASING SERVICES DIVISION

ATTN:

PO Box 94687

SEATTLE, WA 98124-4678

1. In the “Certificate Holder” field of the certificate of insurance, write “Attention: City of Seattle.”

2. Upon award of the Contract, Vendor shall, at its sole expense and for the entire term of the Contract, provide insurance coverage to the City of Seattle (“City”) as checked below within 15 days or the City may withdraw its intent to award:

· ( COMMERCIAL GENERAL LIABILITY (CGL), MARINE GENERAL LIABILITY (MGL) OR EQUIVALENT INCLUDING:

( PREMISES

( PRODUCTS-COMPLETED OPERATIONS

( CONTRACTUAL LIABILITY

( STOP GAP/EMPLOYER’S LIABILITY (UNLESS NO OBLIGATION TO INSURE WA STATE WC)

XCU AND SUBSIDENCE PERILS NOT EXCLUDED

PRODUCTS/COMPLETED OPNS. ADD’L INSURED FOR THREE (3) YEARS FOLLOWING END OF CONTRACT

· MINIMUM LIMITS OF LIABILITY SHALL BE:

· ( BUSINESS AUTOMOBILE LIABILITY INSURANCE FOR OWNED, NON-OWNED, LEASED AND HIRED VEHICLES AS APPROPRIATE written on a form CA 00 01 or equivalent WITH MINIMUM LIMITS OF LIABILITY OF $1,000,000 CSL.

· NOTE: GARAGE LIABILITY WITH APPROPRIATE COVERAGES AND LIMITS OF LIABILITY MAY SUBSTITUTE FOR CGL AND AUTOMOBILE INSURANCE:

· Garage Keeper’s Legal Liability (GKLL) insurance to cover vehicles in vendor’s bailment. Minimum limit of liability of

$ each vehicle and $ each occurrence.

· “On-Hook” GKLL coverage required with minimum limit of liability of $ each vehicle.

IN-TRANSIT POLLUTION LIABILITY CA 99 48/MCS-90 (N/A IF COVERED UNDER AN IN-TRANSIT EXTENSION OF A CONTRACTOR’S POLLUTION LIABILITY INSURANCE POLICY)

· ( WORKER'S COMPENSATION INSURANCE FOR WASHINGTON STATE AS REQUIRED BY TITLE 51 RCW.

UMBRELLA/EXCESS/BUMBERSHOOT LIABILITY INSURANCE OVER CGL/MGL/AUTOMOBILE LIABILITY

MINIMUM LIMIT OF LIABILITY SHALL BE $ CSL ($ MINIMUM TOTAL LIMITS REQUIREMENT)

CONTRACTOR’S POLLUTION LIABILITY INSURANCE. MINIMUM LIMITS OF LIABILITY SHALL BE $1,000,000 $ EACH CLAIM WITH A MINIMUM AGGREGATE LIMIT OF 200% OF THE EACH CLAIM LIMIT. THERE SHALL BE NO REQUIREMENT FOR A DEDICATED PROJECT AGGREGATE LIMIT PROVIDED THAT THE CONTRACTOR SHALL (1) SUBMIT TO THE CITY WITH ITS INSURANCE CERTIFICATION A WRITTEN STATEMENT FROM ITS AUTHORIZED INSURANCE REPRESENTATIVE THAT THE FULL MINIMUM AGGREGATE LIMIT IS AVAILABLE AND HAS NOT BEEN IMPAIRED BY ANY CLAIMS RESERVED ON ANOTHER PROJECT, AND (2) THEREAFTER, UNTIL THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL PROVIDE NOTICE IN WRITING TO THE CITY WITHIN TEN (10) DAYS OF CONTRACTOR’S CONSTRUCTIVE KNOWLEDGE OF ANY PENDING OR ACTUAL IMPAIRMENT OF THE AGGREGATE LIMIT.

AVIATION LIABILITY INSURANCE WITH MINIMUM LIMITS OF $1,000,000 CSL OR $ CSL

PROFESSIONAL LIABILITY INSURANCE WITH MINIMUM LIMIT OF LIABILITY $ EACH CLAIM

WATERCRAFT/P&I LIABILITY INSURANCE WITH MINIMUM LIMITS OF LIABILITY $

SHIP REPAIRER’S OR MARINA OPERATOR’S LEGAL LIABILITY INSURANCE COVERING THE VENDOR’S LIABILITY FOR LOSS OR DAMAGE, INCLUDING LOSS OF USE, TO OWNERS OF WATERCRAFT WHILE IN THE VENDOR’S CARE, CUSTODY AND CONTROL FOR THE PURPOSE OF BEING REPAIRED OR SERVICED.

MINIMUM LIMITS OF LIABILITY SHALL BE $ EACH VESSEL

TOWER’S LEGAL LIABILITY INSURANCE

Any tower hired by the Vendor or any subcontractor shall carry for any tow of the vessel within …….. Such insurance limits shall be for not less than the portion of the Total Contract Price allocable to such vessel (and in no event less than the replacement cost for such vessel), to cover loss, damage and/or expense to the City of Seattle arising out of such towage.

JONES ACT LIABILITY WITH MINIMUM LIMITS $1,000,000 OR $ .

U.S.L. & H. LIABILITY INSURANCE WITH MINIMUM LIMITS OF LIABILITY $

FORMCHECKBOX

Crime Fidelity, Theft, Disappearance & Destruction Liability (to include Employee THEFT, wire transfer, forgery & mail coverage, and client coverage): WITH MINIMUM LIMIT $

FORMCHECKBOX

TECHNOLOGY ERRORS & OMISSION / Professional Liability Insurance with an aggregate limit of liability not less than $

FORMCHECKBOX

Information Technology –Cyber Liability (Network Security Liability and Privacy Liability) with minimum limit $ An attack that has the intent to affect, alter, copy, corrupt, destroy, disrupt, damage, or provide unauthorized access or unauthorized use of Vendor’s computer system; Computer Crime or Information Theft; Denial of Service; Extortion; Introduction, implantation, or spread of a Computer Virus; Loss of Service; Identity Theft; Infringement; Electronic data loss and restoration; Unauthorized Access or Use, including the gaining of access to Vendor’s computer systems by an unauthorized person or persons or an authorized person in an unauthorized manner.

FORMCHECKBOX

Sublimit for Notification Costs: $

. OTHER: WITH MINIMUM LIMIT $

TERMS AND CONDITIONS:

1. City of Seattle as Additional Insured: The CGL/MGL insurance shall include “the City of Seattle” as an additional insured for primary and non-contributory limits of liability.

2. No Limitation of Liability: Insurance coverage and limits of liability as specified herein are minimum coverage and limit of liability requirements only; they shall not be construed to limit the liability of Vendor or any insurer for any claim that is required to be covered hereunder to less than the applicable limits of liability stated in the declarations. Moreover, the City shall be an additional insured, where additional insured status is required, for the full available limits of liability maintained by vendor, whether those limits are primary, excess, contingent or otherwise. Vendor expressly understands and agrees that this provision shall override any limitation of liability or similar provision in any agreement or statement of work between the City and Vendor.

3. Required Separation of Insured Provision; Cross-Liability Exclusion and other Endorsements Prohibited: Vendor’s insurance policy shall include a “separation of insureds” or “severability” clause that applies coverage separately to each insured and additional insured, except with respect to the limits of the insurer’s liability. Vendor’s insurance policy shall not contain any provision, exclusion or endorsement that limits, bars, or effectively precludes the City of Seattle from coverage or asserting a claim under the Vendor’s insurance policy on the basis that the coverage or claim is brought by an insured or additional insured against an insured or additional insured under the policy. Vendor’s CGL policy shall NOT include any of the following Endorsements (or their equivalent endorsement or exclusions): (a) Contractual Liability Limitation, (CGL Form 21 39 or equivalent), b) Amendment Of Insured Contract Definition, (CGL Form 24 26 or equivalent), (c) Limitation of Coverage to Designated Premises or Project, (CGL Form 21 44 or equivalent), (d) any endorsement modifying or deleting the exception to the Employer’s Liability exclusion, (e) any “Insured vs. Insured” or “cross-liability” exclusion, and (f) any type of punitive, exemplary or multiplied damages exclusion. Vendor’s failure to comply with any of the requisite insurance provisions shall be a material breach of, and grounds for, the immediate termination of the Contract with the City of Seattle; or if applicable, and at the discretion of the City of Seattle, shall serve as grounds for the City to procure or renew insurance coverage with any related costs of premiums to be repaid by Vendor or reduced and/or offset against the Contract.

4. Claims Made Form: If any policy is written on a claims made form, the retroactive date shall be prior to or coincident with the effective date of this contract. Claims made coverage shall be maintained by the Vendor for a minimum of three (3) years following the expiration or earlier termination of this contract, and the Vendor shall provide the City with evidence of insurance for each annual renewal. If renewal of the claims made form of coverage becomes unavailable or economically prohibitive, the Vendor shall purchase an extended reporting period (“tail”) or execute another form of guarantee acceptable to the City to assure financial responsibility for liability assumed under the contract.

5. Deductibles and Self-Insured Retentions: Any self-insurance retention or deductible in excess of $ 25,000 that is not “fronted” by an insurer and for which claims the vendor or its third-party administrator is directly responsible for defending and indemnifying must be disclosed on the certificate of liability insurance. Vendor agrees to defend and indemnify the City under its self-insured or deductible layer and upon City’s request advise the full delivery address of the individual or department to whom a tender of a claim should be directed.

6. Notice of Cancellation: Under RCW 48.18.290 (“Cancellation by insurer”) applicable to insurers licensed to do business in the State of Washington, the City, as a certificate holder for the insurance requirements specified herein and an additional insured, has an interest in any loss which may occur; written notice of cancellation must therefore be actually delivered or mailed to the City not less than 45 days prior to cancellation (10 days as respects non-payment of premium). As respects surplus lines placements, written notice of cancellation shall be delivered not less than 30 days prior to cancellation (10 days as respects non-payment of premium).

7. Qualification of Insurers: Insurers shall maintain A.M. Best’s ratings of A- VII unless procured as a surplus lines placement under RCW chapter 48.15, or as may otherwise be approved by the City.

8. Changes in Insurance Requirements: The City shall have the right to periodically review the adequacy of coverages and/or limits of liability in view of inflation and/or a change in loss exposures and shall have the right to require an increase in such coverages and/or limits upon ninety (90) days prior written notice to the Vendor. Should Vendor, despite its best efforts, be unable to maintain any required insurance coverage or limit of liability due to deteriorating insurance market conditions, it may upon thirty (30) days prior written notice request a waiver of any insurance requirement, which request shall not be unreasonably denied.

9. Evidence of Insurance: Vendor must provide the following evidence of insurance:

a. A certificate of liability insurance evidencing coverages, limits of liability and other terms and conditions as specified herein;

b. An attached City of Seattle designated additional insured endorsement or blanket additional insured wording to the CGL/MGL (and if required Contractor’s Pollution Liability insurance policy).

c. A copy of all other amendatory policy endorsements or exclusions of Vendor’s insurance CGL/MGL policy that evidences the coverage required.

At any time upon the City’s request, Vendor shall also cause to be timely furnished a copy of declarations pages and schedules of forms and endorsements. In the event that the City tenders a claim or lawsuit for defense and indemnity invoking additional insured status, and the insurer either denies the tender or issues a reservation of rights letter, Vendor shall also cause a complete and certified copy of the requested policy to be timely furnished to the City.

Send evidence of insurance to the City at the addresses at the top of this form.

For questions or issues about insurance, contact the City of Seattle Risk Management Unit at (206) 386-0071 or by email at Travis.Steichen@seattle.gov.

NOTE: CERTIFICATES WITHOUT ATTACHED ADDITIONAL INSURED ENDORSEMENT OR BLANKET ADDITIONAL INSURED COVERAGE FOR THE CITY OF SEATTLE WILL NOT BE APPROVED!

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Page 1 of 3 Pages Edition 5/5/15

RM contact info revised 01/14/2022