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P a g e 19 o f 20 <br /> <br />applicant organization’s letterhead indicating exemption and specify the person(s), business, etc. that is <br />responsible for paying this fee. <br /> <br />e) Certificate of Liability Insurance <br />A copy of the applicant organization’s current certificate, from the organization’s insurance carrier. <br />Table 1 below outlines insurance types and minimums required, for each jurisdiction. If exempt from <br />Worker’s Compensation compliance, include a statement explaining why, with the applicant <br />organization’s application materials. <br /> <br />NOTE: Proof of insurance is not required at the time of application submission. If your agency is <br />approved for funding, documentation of insurance must be provided to the jurisdiction awarding the <br />funding when the contract is awarded. The insurance certificate should reflect the funding jurisdiction as <br />an additional insured party and certificate holder and provide coverage for the duration of the funding <br />period (as early as February 1, 2021 through January 30, 2023). If proof of insurance can only be written <br />for one year, an update will be required for all ongoing projects. Renewal certificates must be sent to <br />the jurisdiction 30 days prior to any expiration date, cancellation, or modification of any stipulated <br />insurance coverage. <br /> <br />NOTE: Upon request, insurance requirements may be reviewed on a case by case basis by the County. <br />Please contact the staff identified on the Submission Requirements on Page 15 if you have questions or <br />would like to request a review of your insurance requirements. <br /> <br />Appendix <br />Table 1. Forms of Liability Insurance and Minimum Policy Amounts Required <br /> <br />INSURANCE ORANGE COUNTY3 <br />Worker's <br />Compensation1 <br />Limits for Coverage A - Statutory State NC, for each <br />employee <br /> <br />Limits for Coverage B - Employers Liability of: <br />$500,000 each accident, $500,000 BID for each employee <br />$500,000 for BID limit <br />Commercial <br />General Liability <br />$1 million Each Occurrence <br />$2 million Aggregate <br />Automobile <br />Liability $1 million Each Occurrence <br />Professional <br />Liability <br />$1 million Each Occurrence <br />$2 million Aggregate <br />Sexual Abuse & <br />Molestation <br />$1 million Each Occurrence <br />$2 million Aggregate <br />Cyber Liability $1 million Each Occurrence <br />$2 million Aggregate <br /> <br />DocuSign Envelope ID: 0E2E518B-BEF7-4AF0-8D07-FCD05F094BD6