LUA_Insurance_Guide.pdf

Land Use Agreements: Guide to Insurance Documentation Requirements May 16, 2018

Department of Fish and Wildlife

Business Management Branch 1

Land Use Agreements:

Guide to Insurance Documentation Requirements

Contents

Overview of Land Use Agreement Insurance Documentation Element 1: Certificate of Liability Insurance (sample on next page)

Element 2: Primary and Noncontributory Endorsement Elements 3 and 4: Additional Insured Endorsements Element 5: Waiver of Subrogation Element 5: Workers’ Comp Insurance Waiver Letter: Business Entity Awardee

Element 5: Workers’ Comp Insurance Waiver Letter: Individual, No Business Name . 8

Overview of Land Use Agreement Insurance Documentation

The execution of any Land Use Agreement is contingent upon approval of the awardee’s insurance documentation. Approval is determined by the insurance experts of the Department of General Services Office of Risk and Insurance Management (ORIM). This guide is provided to help programs and bidders understand and meet the insurance documentation requirements that drive ORIM’s approval.

Land Use Agreement insurance documentation that ORIM reviews typically includes five elements:

1. Certificate of Liability Insurance (COI)

2. Primary and Noncontributory Endorsement

3. Additional Insured Endorsement for either Commercial General Liability or Farm

Liability

4. Additional Insured Endorsement for Automobile Liability

5. Either a Waiver of Subrogation (for Workers’ Compensation) in favor of the

State, or a Workers’ Compensation Insurance Waiver Letter

Our explanations of the five required elements are specific. Our document samples, however, are only generally informative, because we understand that some of the documents insurers provide to us might not have the exact appearance or structure as our samples; for example, there might be separate Commercial General and Automobile providers and COIs, or, different Additional Insured Endorsements might be combined onto one Additional Insureds document.

Programs, contact the Land Use Agreements analyst in BMB if you have any questions.

Bidders, contact your CDFW program contact if you have questions.

Department of Fish and Wildlife

Business Management Branch 2

Element 1: Certificate of Liability Insurance (sample on next page)

Document is dated and Broker/Producer contact information is provided.

The name of the “insured” must be EXACTLY as it appears on the Certification Form from their bid/proposal

The Insurer(s) affording coverage must be rated at least A--/FSC Class VII by A.M. Best Company.

The document is signed (usually on the bottom) Commercial General Liability

Policy number and effective and expiration dates are filled in. Confirm the commencement date falls within these dates.

There is a check mark in additional insured

Limit for “Each Occurrence” matches the permit/lease (min $1,000,000)

Limit for Damage to Rented Premises (former: Fire Legal) matches permit/lease (min $300,000)

Limit for General Aggregate matches the permit/lease (min $3,000,000) NOTE: Farm Liability may be used in place of Commercial General; however if the insurance carrier cannot meet the Aggregate (min of $3,000,000) an Excess/Umbrella liability in the amount is acceptable.

Automobile Liability

Policy number and effective and expiration dates are filled in. Confirm the commencement date falls within these dates.

There is a check mark in additional insured

There is a check mark in “all owned autos”, “hired autos” and “non-owned autos” OR a mark in “any autos”

Limit for “Combined Single Limit for each accident” matches the permit/lease (min $1,000,000)

Workers Compensation and Employer’s Liability

Policy number and effective and expiration dates are filled in. Confirm the commencement date falls within these dates.

Limit for “Each Accident” matches the permit/lease (min $1,000,000) NOTE: If a Permittee/Lessee does not have any employees, they can waive Workers Comp Insurance by providing of signed Workers Compensation Waiver letter. See Element 4 for a sample Waiver Letter.

Description of Operations Area

Permit or Lease number is identified in this area.

Naming CDFW as additional insured in this area will not replace the required Additional Insured Endorsement Documents.

Certificate Holder Area

This area must indicate a Fish and Wildlife as the holder and the address must be a CDFW location. Regional offices are OK.

Naming CDFW as additional insured in this area will not replace the required Additional Insured Endorsement Documents.

http://www3.ambest.com/ratings/entities/CompanyProfile.aspx?ambnum=60166&URatingId=2566328&bl=0&AltSrc=9&PPP=&AltNum=0&Ext_User=&Ext_Misc=

Department of Fish and Wildlife

Business Management Branch 3

Department of Fish and Wildlife

Business Management Branch 4

Element 2: Primary and Noncontributory Endorsement

This element responds to Section 21(h) of the Agreement, which states:

(h) Primary Clause: Any required insurance contained in this Permit shall be primary, and not excess or contributory, to any other insurance carried by the State.

The wording above and the sample Endorsement below, were provided by our Department of General Services Office of Risk and Insurance Management (ORIM).

Department of Fish and Wildlife

Business Management Branch 5

Elements 3 and 4: Additional Insured Endorsements

For ORIM approval, the Additional Insured on the COI will not replace the required Additional Insured Endorsement Documents.

for Commercial General Liability

Insurer is identified and matches the insurer name on the certificate

Policy number matches the number of the certificate

Shows the “State of California, its officers, agents, and employees” as additional insureds insofar as the operations under this Permit or Lease are concerned

Document must be signed.

NOTE: If Farm Liability is used in place of Commercial General an additional insured endorsement for Farm Liability must be provided. The information above applies to Farm Liability as well.

for Automobile Liability Insurer is identified and matches the insurer name on the certificate

Policy number matches the number of the certificate

Shows the “State of California, its officers, agents, and employees” as additional insureds insofar as the operations under this Permit or Lease are concerned

Document must be signed.

Department of Fish and Wildlife

Business Management Branch 6

Element 5: Waiver of Subrogation

Waiver of Subrogation in favor of the State for Workers’ Compensation

Insurer is identified and matches the insurer name on the certificate

Policy number matches the number of the certificate

Document must be signed.

or

Workers’ Compensation Insurance Waiver Letter

(See next page for examples)

Department of Fish and Wildlife

Business Management Branch 7

Element 5: Workers’ Compensation Insurance Waiver Letter:

Business Entity Awardee

Submit a workers’ compensation insurance waiver letter with your other insurance documentation, if you don’t have employees engaged in the performance of activities under this Permit.

Create the letter on your letterhead stock.

If you are an individual awardee, and not using a business name other than your name, use the “Individual Awardee” example shown on the next page.

Letterhead

Authorized Signer’s Name Business name as it appears on the Award Street address City, State, Zip Code

January 20, 2017

Re: Workers Compensation

To Whom it May Concern:

Please note that Business name as it appears on the Award will have no employees engaged in the performance of activities under this Permit Permit number. Because of this, Business name as it appears on the Award is not required to have workers' compensation insurance, and has elected to not have that insurance.

Should Business name as it appears on the Award choose to engage employees in the performance of activities under this Permit in the future, Business name as it appears on the Award will, in compliance with California Labor Code, obtain appropriate workers' compensation insurance prior to any such engagement.

Sincerely, Authorized Signer’s Signature

Business Title

Department of Fish and Wildlife

Business Management Branch 8

Element 5: Workers’ Compensation Insurance Waiver Letter:

Individual Awardee, No Other Business Name

Submit a workers’ compensation insurance waiver letter with your other insurance documentation, if you don’t have employees engaged in the performance of activities under this Permit.

Create the letter on your letterhead stock.

If you are a business entity use the “Business Entity Awardee” example on the prior page.

Letterhead

Awardee’s name as it appears on the Award Street address City, State, Zip Code

January 20, 2017

Re: Workers Compensation

To Whom it May Concern:

Please note that I, Awardee’s name as it appears on the Award, will have no employees engaged in the performance of activities under this Permit Permit number. Because of this, I am not required to have workers' compensation insurance, and have elected to not have that insurance.

Should I choose to engage employees in the performance of activities under this Permit in the future, I will, in compliance with California Labor Code, obtain appropriate workers' compensation insurance prior to any such engagement.

Sincerely, Signature of Awardee