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P a g e 21 o f 2 3 <br />This fee finances Orange County's recycling and waste reduction program. Submit either a.) <br />proof of payment of the applicant organization’s FY 2019-20 Solid Waste Program Fee, OR b.) a <br />statement on the applicant organization’s letterhead indicating exemption and specify the <br />person(s), business, etc. that is 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 <br />carrier. Table 1 below outlines insurance types and minimums required, for each jurisdiction. If <br />exempt from Worker’s Compensation compliance, include a statement explaining why, with the <br />applicant organization’s application materials. <br /> <br />NOTE: Proof of insurance is not required at the time of app lication submission. If your agency <br />is approved for funding, documentation of insurance must be provided to the jurisdiction <br />awarding the funding when the contract is awarded. The insurance certificate should reflect the <br />funding jurisdiction as an additio nal insured party and certificate holder and provide coverage for <br />the duration of the funding period (two years, beginning as early as October 1, 2021). If proof of <br />insurance can only be written for one year, an update will be required for all ongoing projects. <br />Renewal certificates must be sent to the jurisdiction 30 days prior to any expiration date, <br />cancellation or modification of any stipulated insurance coverage. <br /> <br />NOTE: Upon request, insurance requirements may be reviewed on a case by case basis by the <br />County. Please contact the staff identified on the Submission Requirements on Page 15 if you <br />have questions or would like to request a review of your insurance requirements. <br /> <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 <br />each employee <br /> <br />Limits for Coverage B - Employers Liability of: <br />$500,000 each accident, $500,000 Bodily Injury <br />by Disease (BID).for each employee <br />$500,000 for BID limit <br />Commercial General <br />Liability <br />$1 million Each Occurrence <br />$2 million Aggregate <br />Automobile Liability $1 million Each Occurrence <br />Professional Liability $1 million Each Occurrence <br />$2 million Aggregate <br />Sexual Abuse & <br />Molestation <br />$1 million Each Occurrence <br />$2 million Aggregate <br />DocuSign Envelope ID: AFC9D9B8-B7DD-46DF-8603-54762363FD20