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P a g e 17 o f 18 <br /> <br /> <br />d) 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 (two years, beginning as early as October 1, 2023). If proof of insurance can only be written for <br />one year, an update will be required for all ongoing projects. Renewal certificates must be sent to the <br />jurisdiction 30 days prior to any expiration date, cancellation or modification of any stipulated insurance <br />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 /> <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 employee <br /> <br />Limits for Coverage B - Employers Liability of: <br />$500,000 each accident, $500,000 Bodily Injury by Disease <br />(BID) for each employee <br />$500,000 for BID limit <br />Commercial General Liability <br /> <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 & Molestation $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 Liability <br />(Required if demolition, use of hazardous <br />material or environmentally sensitive) <br />$1 million Each Occurrence <br />DocuSign Envelope ID: DBE8454E-5CDD-4377-A739-3C0016853D4E