Table C - Appendix # 12 - Railroad Protective Liability (RRPL) Application.pdf

RAILROAD PROTECTIVE LIABILITY APPLICATION

Name and Address Maryland Transit Administration Of Railroad (Insured): Office of Safety Management & Risk Control 1515 Washington Blvd. Baltimore, MD 21230

Name and Address _______________________________________________ _____ Of Designated Contractor(s): _______________________________________________ _____

Contractor's General Liability Limits/Carrier: ________________________________________

Contractor's Umbrella/Excess Limits/Carrier: _______________________________________

Will RR be listed as an Additional Insured on the Contractor's GL Policy? ____ Yes ____ No

Will the Contractor be holding the RR harmless for this job? ____ Yes ____ No

Will the contractual exclusion for work within 50 feet of a RR be deleted from the contractor's GL and Umbrella/Excess Policies for this job? ____ Yes ____ No

Name and address of involved Governmental Authority (if applicable):

Railroad Protective Limits Desired: ( ) $2,000,000 CSL per occ./$6,000,000 agg.

( ) $5,000,000 CSL per occ./$10,000,000 agg.

Bid Date: _________ Policy Period: From: __________ To: __________

Name and Address __________________________________________________________ for whom work is being __________________________________________________________ performed (if not MTA) ___________________________________________________________

Description of Job: __________________________________________________________ (include job/ __________________________________________________________ contract #) __________________________________________________________

Location of Job: __________________________________________________________ (include City/State) __________________________________________________________

Note: Work within 50 ft of the RR owner’s property or right-of-way is excluded on the Contractor’s

General Liability Policy due to the contract work with MTA. Coverage is afforded by CG 2417. Covered autos within 50 ft. of the RR owner’s property at a designated job site may not be covered. Coverage is afforded by CA 2070. Be sure to contact your insurance broker to complete this application and address your concerns. The RRPL Policy is to protect MTA, not the Contractor.

Anticipated length of job (years/months): __________________________

Anticipated length of work within 50’ of RR tracks, property and/or right-of-way (years/months): ___________

Total Job Cost:______________ Job Cost w/in 50’ of RR tracks, property and/or right-of-way:____________

Is Construction: ( ) Parallel to, ( ) Over, ( ) Under, or ( ) On the RR tracks

Daily train traffic: Freight: n/a Passenger: _________________

Will the RR provide any flagmen or supervisory personnel for this job? ____ Yes ____ No

Will the RR provide any other employees to do work for this job? ___ Yes ____ No - If yes, please explain: _______________________________________________________________________

Will the RR loan any equipment to the contractor for this job? ____ Yes ___ No - If yes, not eligible for RRPL

Any track movement involved with this job? ____ Yes ____ No - If yes, please explain:

Any blasting/tunneling involved with this job? ____ Yes ____ No – If yes, explain:

What utility lines are in right of way?

Signature Date

Subject to the following:

The contractors General Liability Program and Excess Program on a combined occurrence basis must be equal to or greater than the occurrence limit offered under the Railroad Protective policy.

A copy of the contractor’s insurance certificate or written documentation would be required at the time of binding.

General Liability Carrier and Excess Carrier must have a minimum A.M. Best rating of "A-IX" or better.

Contract will hold Railroad Harmless, add railroad as additional insured on contractors General Liability policy, and the contractual exclusion for work within 50ft has been deleted from the contractors General Liability and Umbrella policies.

No Railroad Employees provided to project outside of flagging and or supervisory personnel.

No loaning of railroad equipment.

Please include any necessary attachments

Please make check payable to:

Maryland Transit Administration Office of Safety Management & Risk Control 1515 Washington Blvd., Suite 2200 B Baltimore, MD 21230-1794 ATTN: Sharyn K. Malachi, Risk Analyst, CRIS MBA Phone: 770-527-1287

RailRoad Protective Liability Category Descriptions

Incidental Operations* not inclusive of all incidental operations

Field surveys

Appraisals

Billboards

Film contracts

Bridge Inspections

Painting overhead bridges

Core borings

Entry Permits to other entities

Pipe / Wire/ Cable Agreements* not inclusive of all underground & overhead operations

Underground more than 2500 ft. refer to risk management

Fiber Optic refer to risk management

Sewer improvements and repair

Water pipes improvements and repairs

Utility improvements and repair

Blanket Contractors Values Less Than $15,000,000.00

Values over $15,000,000.00 refer to risk management for referral to insurer

Landscaping

Pest Control

Snow Removal

Placement of Engineering/Architectural Equipment to monitor sound/movement

Inventory

Ancillary Contracts with contractor provided insurance requirements

Construction Contracts Rate for 2,000,000/6,000,000 Limits is .70 per $100 of Construction Contract Cost within 50ft of railroad

Subject to a $1,000 Minimum premium

Rate for 5,000,000/10,000,000 Limits is .95 per $100 of Construction Contract Cost within 50ft of railroad.

Subject to a $2,500 Minimum premium

Construction Contract of $15,000,000 or greater within right of way require referral to the underwriter for approval

ROE and Temporary Occupancy Permits $300 - up to 30 Days $450 - 31 to 90 Days $650 - 91 to 120 Days $800 - over 120 days