Insurance Requirement Form

Insurance Requirement Form
Minimum Insurance Coverages – The selected consultant shall, at its own expense, obtain and
maintain in effect at all times the following types of insurance against claims, damages and losses due
to injuries to persons or damage to property or other losses that may arise in connection with the
performance of work under this Contract, placed with insurers with a Best’s rating of A-X or better.
Yes (√)
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Please certify by checking the boxes at left that required coverages will be provided within five
(5) days of Alameda CTC’s notice to firm that it is the successful proposer.
Workers' Compensation Insurance in the amount required by the applicable laws, and
Employer’s Liability insurance with a limit of not less than $1,000,000 per employee and
$1,000,000 per occurrence, and any and all other coverage of Proposers’s employees as may be
required by applicable law. Such policy shall contain a Waiver of Subrogation endorsement in
favor of Alameda CTC. Such Workers Compensation & Employers Liability may be waived,
if, and only for as long as, the selected consultant is a sole proprietor with no employees.
Commercial General Liability Insurance for Bodily Injury and Property Damage liability,
covering the operations of the selected consultant and its officers, agents, and employees and
with limits of liability which shall not be less than $1,000,000 combined single limit per
occurrence with a general aggregate liability of not less than $2,000,000, and Personal &
Advertising Injury liability with a limit of not less than $1,000,000. Expense for Indemnitee’s
defense costs shall be outside of policy limits and such policy shall be issued on a Duty to
Defend Primary Occurrence Form.
Alameda CTC, FHWA (if applicable), MTC (if applicable), Caltrans and their respective
commissioners, directors, officers, representatives, agents and employees are to be named as
additional insureds. Such insurance as afforded by this endorsement shall be primary as
respects any claims, losses or liability arising directly or indirectly from the selected consultant’s
operations.
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Business Automobile Insurance for all automobiles owned, used or maintained by Proposer
and Proposer’s officers, agents and employees, including but not limited to owned, leased, nonowned and hired automobiles, with limits of liability which shall not be less than $1,000,000
combined single limit per occurrence.
Umbrella Insurance in the amount of $1,000,000 providing excess limits over Employer’s
Liability, Automobile Liability, and Commercial General Liability Insurance.
Property Insurance covering the selected consultant’s own business personal property and
equipment to be used in performance of this Contract, materials or property to be purchased
and/or installed on behalf of Alameda CTC (if any), debris removal (if applicable), and builders
risk for property in the course of construction (if applicable). Coverage shall be written on a
"Special Form" ("All Risk") that includes theft, but excludes earthquake, with limits at least
equal to the replacement cost of the property. Such policy shall contain a Waiver of
Subrogation in favor of Alameda CTC. If such insurance coverage has a deductible, the selected
consultant shall also be liable for the deductible.
Deductibles: Any deductibles or self-insurance retentions over $50,000 are subject to the approval of
Alameda CTC.
Notice of Termination: All policies shall provide that the insurance carrier shall give written notice to
Alameda CTC at least 30 days prior to cancellation, non-renewal or material change of coverage in the policy
or policies, and shall provide notice of such change to Alameda CTC and any other additional insured.
Additional Provisions: Each policy or policies of insurance described in Commercial General Liability
Insurance, above shall include an endorsement providing that such insurance is primary insurance and no
insurance of Alameda CTC will be called on to contribute to a loss.:
Certificates of Insurance: Promptly on execution of this Contract and prior to commencement of any work
hereunder, the consultant shall deliver to Alameda CTC Certificates of Insurance verifying the aforementioned
coverages. Such certificates shall make reference to all provisions and endorsements referred to above and
shall be signed on behalf of the insurer by an authorized representative thereof. Proposer agrees, upon written
request by Alameda CTC, to furnish copies of such policies or endorsements required under the Contract
prior to the Effective Date of the Contract.
Disclaimer: The foregoing requirements as to the types of limits of insurance coverage to be maintained by
consultant are not intended to and shall not in any manner limit or qualify the liabilities and obligations
otherwise assumed by consultant pursuant hereto, including, but not limited to, liability assumed pursuant to
indemnification.
Subconsultant’s Insurance: The Consultant shall require each of its subconsultants to provide the
aforementioned coverages, unless such coverages are waived or reduced in writing by the Alameda CTC
Project Manager and Contracting, Administration, and Fiscal Resource Manager.
By signing below, you acknowledge and agree to provide the required certificate of insurance
providing verification of the minimum insurance requirements listed above within five (5) days of
Alameda CTC’s notice to firm that it is the successful proposer.
Authorized Signature
Name and Title
Date
NOTE: If you were unable to check “Yes” for any of the required minimum insurance coverages
listed above, a request for exception to the appropriate insurance requirement(s) must be brought
to Alameda CTC’s attention no later than the date for protesting RFP provisions. If such objections
are not brought to Alameda CTC’s attention consistent with the protest provisions of this RFP,
compliance with the insurance requirements will be assumed.