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Provide the following information about each board of director's member: name, telephone number, address, occupation or affiliation of each member and the list must identify the principal officers of the governing body, and length of term. d) Solid Waste Program Fee(SWPF)Verification This fee finances Orange County's recycling and waste reduction program. Submit either a.)proof of payment of the applicant organization's FY 2018-19 Solid Waste Program Fee,OR b.)a statement on the applicant organization's letterhead indicating exemption and specify the person(s),business,etc.that is responsible for paying this fee. e) Certificate of Liability Insurance A copy of the applicant organization's current certificate, from the organization's insurance carrier. Table 1 below outlines insurance types and minimums required, for each jurisdiction. If exempt from Worker's Compensation compliance,include a statement explaining why,with the applicant organization's application materials. NOTE: Proof of insurance is not required at the time of application submission. If your agency is approved for funding, documentation of insurance must be provided to the jurisdiction awarding the funding when the contract is awarded. The insurance certificate should reflect the funding jurisdiction as an additional insured party and certificate holder and provide coverage for the duration of the funding period(as early as February 1, 2021 through January 30, 2023). If proof of insurance can only be written for one year, an update will be required for all ongoing projects. Renewal certificates must be sent to the jurisdiction 30 days prior to any expiration date, cancellation or modification of any stipulated insurance coverage. NOTE: Upon request, insurance requirements may be reviewed on a case by case basis by the County. Please contact the staff identified on the Submission Requirements on Page 15 if you have questions or would like to request a review of your insurance requirements. APPENDIX Table 1. Forms of Liability Insurance and Minimum Policy Amounts Required INSURANCE ORANGE COUNTY3 Worker's Compensation' Limits for Coverage A-Statutory State NC,for each employee Limits for Coverage B-Employers Liability of: $500,000 each accident,$500,000 BID for each employee $500,000 for BID limit Commercial $1 million Each Occurrence General Liability $2 million Aggregate Automobile Liabili $1 million Each Occurrence Professional $1 million Each Occurrence Liability $2 million Aggregate Sexual Abuse& $1 million Each Occurrence Molestation $2 million Aggregate Cyber Liability $1 million Each Occurrence $2 million Aggregate Page 16 of 17