Sample_Insurance_Certificate.pdf
PDF 141 KB Posted
- Attached to
- Management Consulting Services Retainer RFP (Various) State and local contract opportunity
- Solicitation number
- 26-014
- Issued by
- Washington County, Barlow City, Oregon
About this file
This document is a Contractual Insurance Requirements document for the City of Beaverton, Oregon, detailing specific insurance policy coverage mandates for contractors. The requirements specify comprehensive insurance coverage across multiple policy lines including General Liability (with $2,000,000 each occurrence and aggregate limits), Automobile Liability (with $1,000,000 combined single limit), Workers Compensation (with statutory limits and $500,000 per accident/disease limits), and potential Property and Boiler/Machinery coverage.
The document outlines additional requirements for insurance certificates, including mandatory Additional Insured endorsements for both the City of Beaverton and its officials, employees, agents, and volunteers. Contractors must provide proof of coverage for General Liability, Automobile Liability, and Workers Compensation, with specific stipulations such as accepting various auto coverage configurations and requiring confirmation that no proprietors/partners/executives are excluded from workers compensation coverage. The certificate holder is listed as City of Beaverton c/o myCOI in Indianapolis, Indiana, suggesting the use of a third-party insurance verification service to manage these contractual insurance requirements.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| Management_Consulting_Services_Retainer_RFP_(Various)_(Addendum_#5_Revision).pdf | ||
| Management_Consulting_Services_Retainer_RFP_(Various)_(Addendum_#4_Revision).pdf | ||
| Sample_Insurance_Certificate.pdf | ||
| Sample_Contract.pdf | ||
| Sample_Contract.pdf |
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Text version
CONTRACTUAL INSURANCE REQUIREMENTS
The information contained herein is to describe the contractual requirements that City of Beaverton, Oregon has indicated to myCOI. These contractual requirements should NOT be used to provide inaccurate information regarding current insurance policies. Questions regarding interpretation of this document can be directed to our support team at 317-759-9426.
INSURED
CARRIER REQUIREMENTS
POLICY LINE POLICY LIMITS
GENERAL
LIABILITY
EACH OCCURRENCE $ 2,000,000
CLAIMS MADE DAMAGE TO RENTED PREMISES (Ea occurrence)
X OCCUR MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $ 2,000,000
GEN’L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ Included
POLICY X PROJECT LOCATION $
AUTO
LIABILITY
COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000
X ANY AUTO BODILY INJURY (Per person) $
ALL OWNED AUTOS BODILY INJURY (Per accident) $
SCHEDULED AUTOS PROPERTY DAMAGE (Per accident) $
HIRED AUTOS
NON-OWNED AUTOS
UMBRELLA
/EXCESS
LIABILITY
OCCUR EACH OCCURRENCE $
Claims Made AGGREGATE $
WORKERS
COMP
/EMPLOYEE
LIABILITY
X
WC
STATUTORY
LIMITS
OTHER
E.L. EACH ACCIDENT $ 500,000
E.L. DISEASE - EA EMPLOYEE $ 500,000
E.L. DISEASE - POLICY LIMIT $ 500,000
Property
Property Causes of Loss Deductibles Building $
Basic Building Personal Property $
Broad Contents Business Income $
Special Extra Expense $
Earthquake Rental Value $
Wind Blanket Building $
Flood Blanket Pers Prop $
Blanket BLDG & PP $
Boiler and Machine
Boiler & Machinery /Equipment Break Down $
Certificate Holder
City of Beaverton C/O: myCOI P.O. Box# 501970, 8710 Bash Street Indianapolis, IN 46256
ADDITIONAL REQUIREMENTS
- General Liability
- Umbrella or Excess Liability may be used to meet policy limits.
- Please provide copies of the Additional Insured endorsement for both ongoing and completed operations in addition to the certificate of insurance.
- Please confirm on the certificate or by uploading endorsement(s) that Additional Insured applies to this policy.
- Additional Insured Names: City of Beaverton and its officials, employees, agents, and volunteers,
- Additional Insured applies to General Liability.
Automobile Liability
- All Owned, Hired & Non-Owned Autos OR Scheduled, Hired & Non-Owned Autos OR Hired and Non-Owned Autos will be accepted in lieu of the Any Auto requirement.
- Umbrella or Excess Liability may be used to meet policy limits.
- Please provide copies of the Additional Insured endorsement in addition to the certificate of insurance.
- Please confirm on the certificate or by uploading endorsement(s) that Additional Insured applies to this policy.
- Additional Insured Names: City of Beaverton and its officials, employees, agents, and volunteers,
- Additional Insured applies to Automobile.
- Please confirm that no proprietor/partner/executive/officer/member is excluded. If there are exclusions, please list on certificate and please indicate whether any of these excluded parties visit the job sites.
- If coverage is from a PEO/temp agency, a copy of the Alternate Employers Endorsement must be submitted in addition to the certificate of insurance.
Workers Compensation
File details come from the government source that posted it. Updated .