Insurance Requirements.pdf

9/9/22

INSURANCE REQUIREMENTS

Please provide a policy Specimen Certificate of Insurance showing current coverage’s along with this form

WORKERS’ COMPENSATION & EMPLOYER LIABILITY

Full Statutory Limits - Employers Liability

$500,000 – Each Accident $500,000 – Each Employee $500,000 – Policy Limit

Waiver of Subrogation in favor of the Village of Orland Park

AUTOMOBILE LIABILITY (ISO Form CA 0001) $1,000,000 – Combined Single Limit Per Occurrence

Bodily Injury & Property Damage

GENERAL LIABILITY (Occurrence basis) (ISO Form CG 0001) $1,000,000 – Combined Single Limit Per Occurrence

Bodily Injury & Property Damage $2,000,000 – General Aggregate Limit

$1,000,000 – Personal & Advertising Injury $2,000,000 – Products/Completed Operations Aggregate

Additional Insured Endorsements: (not applicable for Goods Only) ISO CG 20 10 or CG 20 26 and CG 20 01 Primary & Non-Contributory

Blanket Waiver of Subrogation in favor of the Village of Orland Park

CG 20 37 Additional Insured – Completed Operations (provide if box is checked)

In addition to the above, please provide the following coverage, if box is checked.

LIABILITY UMBRELLA (Follow Form Policy) $1,000,000 – Each Occurrence $1,000,000 – Aggregate

$2,000,000 – Each Occurrence $2,000,000 – Aggregate

Other: ____________________________________________ EXCESS MUST COVER: General Liability, Automobile Liability, Employers’ Liability

PROFESSIONAL LIABILITY

$1,000,000 Limit – Claims Made Form, Indicate Retroactive Date

$2,000,000 Limit – Claims Made Form, Indicate Retroactive Date

Other: __________________________________________________ Deductible not-to-exceed $50,000 without prior written approval

BUILDERS RISK

Completed Property Full Replacement Cost Limits – Structures under construction

ENVIRONMENTAL IMPAIRMENT/POLLUTION LIABILITY

$1,000,000 Limit for bodily injury, property damage and remediation costs resulting from a pollution incident at, on or mitigating beyond the job site

CYBER LIABILITY

$1,000,000 Limit per Data Breach for liability, notification, response, credit monitoring service costs, and software/property damage

Any insurance policies providing the coverages required of the Consultant, excluding Professional Liability, shall be specifically endorsed to identify “The Village of Orland Park, and their respective officers, trustees, directors, officials, employees, volunteers and agents as Additional Insureds on a primary/non-contributory basis with respect to all claims arising out of operations by or on behalf of the named insured.” The required

9/9/22

Additional Insured coverage shall be provided on the Insurance Service Office (ISO) CG 20 10 or CG 20 26 endorsements or an endorsement at least as broad as the above noted endorsements as determined by the Village of Orland Park. Any Village of Orland Park insurance coverage shall be deemed to be on an excess or contingent basis as confirmed by the required (ISO) CG 20 01 Additional Insured Primary & Non- Contributory Endorsement. The policies shall also contain a Waiver of Subrogation in favor of the Additional Insureds in regard to General Liability and Workers’ Compensation coverage. The certificate of insurance shall also state this information on its face. Any insurance company providing coverage must hold an A-, VII rating according to Best’s Key Rating Guide. Each insurance policy required shall have the Village of Orland Park expressly endorsed onto the policy as a Cancellation Notice Recipient. Should any of the policies be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy provisions.

Permitting the contractor, or any subcontractor, to proceed with any work prior to our receipt of the foregoing certificate and endorsements shall not be a waiver of the contractor’s obligation to provide all the above insurance.

Consultant agrees that prior to any commencement of work to furnish evidence of Insurance coverage providing for at minimum the coverages, endorsements and limits described above directly to the Village of Orland Park, 14700 S. Ravinia Avenue, Orland Park, IL 60462. Failure to provide this evidence in the time frame specified and prior to beginning of work may result in the termination of the Village’s relationship with the contractor.

ACCEPTED & AGREED THIS _____ DAY OF ________________, 20___

Signature Authorized to execute agreements for:

Printed Name & Title Name of Company

POLICY NUMBER: COMMERCIAL GENERAL LIABILITY

CG 20 10 07 04

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED - OWNERS, LESSEES OR

CONTRACTORS - SCHEDULED PERSON OR

ORGANIZATION

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

SCHEDULE

l

A. Section II - Who Is An Insured is' rn,naed to include as an additional insure,d_1be person(s) or organization(s) shown in the {Sc gute, ,but only with respect to liability for "bodlly_1njury"i "property damage" or "personal and ady r§sing injury" caused, in whole or in part, by:

1. Your acts or omissions; or

2. The acts or omissions of those acting on your behalf;

in the performance of your ongoing operations for the additional insured(s) at the location(s) desig nated above.

B. With respect to the insurance afforded to these additional insureds, the following additional exclu sions apply:

This insurance does not apply to "bodily injury" or "property damage" occurring after:

1. All work, including materials, parts or equip ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or

2. That portion of "your work" out of which the injury or damage arises has been put to its in tended use by any person or organization oth er than another contractor or subcontractor engaged in performing operations for a prin cipal as a part of the same project.

CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 □

Name Of Additional Insured Person(s) Or Or :

Location s Of Covered O erations

Information re uired to com lete this Schedule, f:ttpfshown above, will be shown in the Declarations.

CG 20 26 07 04

ADDITIONAL INSURED - DESIGNATED

PERSON OR ORGANIZATION

r\·, ...., A' , Section II - Who Is An lnsuref· r:sime p d to in clude as an additional insured the:per on(sfvr organ ization(s) shown in the Schedul· .ifuto9ly with re spect to liability for "bodily injury", "prpp(efty damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf:

A. In the performance of your ongoing operations; or

B. In connection with your premises owned by or rented to you.

CG 20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 □

"-. "· -........_ i

Information re uired to com lete this Sct:iedule --if-not-shown above, will be shown in the Declarations.

Name Of Additional Insured Person s

SAMPLE COMMERCIAL GENERAL LIABILITY

CG 20 33 0413

CONTRACTORS -AUTOMATIC STATUS WHEN

REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU

A. Section II - Who Is An Insured is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such any professional architectural, engineering or surveying services, including:

a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury"

b. Supervisory, architectural activities.

inspection, or engineering caused, in whole or in part, by:

1. Your acts or omissions; or

2. The acts or omissions of those acting on your behalf;

in the performance of your ongoing operations for the additional insured.

However, the insurance afforded to such additional insured:

1. Only applies to the extent permitted by law;

and

2. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured.

A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed.

B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply:

This insurance does not apply to:

1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying services.

2. "Bodily injury" or "property damage" occurring after:

a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or

b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in

CG 20 33 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2

CG 20 37 07 04

CONTRACTORS- COMPLETED OPERATIONS

Name Of Additional Insured Person(s) Or Or anization s :

Location And Description Of Completed Opera tions

Information re uired to com lete this Schedule, -if'n_oCshown above, will be shown in the Declarations.

\ I/ .' Section II - Who Is An Insured-·is amended to include as an additional insured th --pe.ri n(s) or organization(s) shown in the Sched!;tle; bul,only with respect to liability for "bodily injury;!. e-r/"property damage" caused, in whole or in part, by/"your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products completed operations hazard".

CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 □