Orange County NC Website
Browse       Search
Page 18 of 20 <br /> <br /> <br />c) List of Board of Directors (if applicable) <br />Provide the following information about each board of director’s member: name, telephone number, and address, of <br />each member and the list must identify the principal officers of the governing body, and length of term. Please feel <br />free to use the template provided in Table 2 of the appendix or your own format. <br /> <br />d) Certificate of Liability Insurance <br />A copy of the applicant organization’s current certificate, from the organization’s insurance carrier. Table 1 below <br />outlines insurance types and minimums required, for each jurisdiction. If exempt from Worker’s Compensation <br />compliance, include a statement explaining why, with the applicant organization’s application materials. <br /> <br />NOTE: Proof of insurance is not required at the time of application submission. If your agency is approved for <br />funding, documentation of insurance must be provided to the jurisdiction awarding the funding when the contract is <br />awarded. The insurance certificate should reflect the funding jurisdiction as an additional insured party and certificate <br />holder and provide coverage for the duration of the funding period (two years, beginning as early as October 1, 2023). <br />If proof of insurance can only be written for one year, an update will be required for all ongoing projects. Renewal <br />certificates must be sent to the jurisdiction 30 days prior to any expiration date, cancellation or modification of any <br />stipulated insurance coverage. <br /> <br />NOTE: Upon request, insurance requirements may be reviewed on a case by case basis by the County. Please contact <br />the staff identified on the Submission Requirements on Page 15 if you have questions or would like to request a review <br />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 Compensation1 <br /> <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 Bodily Injury by <br />Disease (BID).for each employee <br />$500,000 for BID limit <br />Commercial General <br />Liability $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 /> <br />Cyber Liability <br /> <br />$1 million Each Occurrence <br />$2 million Aggregate <br />Environmental/Pollution <br />Liability $1 million Each Occurrence <br />DocuSign Envelope ID: 77953783-C404-4AD0-84BA-D739A58B1A83