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P a g e 23 o f 25 <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 jurisd iction 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, 2022). <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 modi fication 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 <br />(Required if demolition, use <br />of hazardous material or <br />environmentally sensitive) <br />$1 million Each Occurrence <br /> <br />▪ Visit the NC Industrial Commission’s website for more information regarding Coverage A. Also, note <br />that if an agency uses subcontractors, it must require subcontractors to have workmen’s <br />compensation insurance. <br />▪ Please visit Orange County’s Risk Management page for more information about the County’s <br />Minimum Insurance Requirements. <br /> <br />DocuSign Envelope ID: 08DD74BE-CE96-4D90-9C72-8BD18C25E2E7