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17 <br /> h) Certificate of Liability Insurance <br /> A copy of the agency's current certificate,from the agency's insurance carrier. Table 1 below outlines insurance <br /> types and minimums required, for each jurisdiction. If exempt from Worker's Compensation compliance, <br /> include a statement explaining why, with the agency's application materials. <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 <br /> contract is awarded. The insurance certificate should reflect the funding jurisdiction as an additional insured <br /> party and certificate holder and provide coverage for the duration of the funding period (July 1 —June 30). <br /> Renewal certificates must be sent to the jurisdiction 30 days prior to any expiration date, cancellation or <br /> modification of any stipulated insurance coverage. <br /> NOTE: Upon request, insurance requirements may be reviewed on a case by case basis by the Town or County. <br /> Please contact the staff identified on the Submission Requirements on Page 2 if you have questions or would <br /> like to request a review of your insurance requirements. <br /> Table 1. Forms of Liability Insurance and Minimum Policy Amounts Required <br /> INSURANCE TOWN OF CARRBORO TOWN OF CHAPEL HILL ORANGE COUNTy3 <br /> Worker's Limits for Coverage A- <br /> Compensationl Statutory State NC,for each <br /> employee <br /> Limits for Coverage B- <br /> Employers Liability of: <br /> $1,000,000 Each Occurrence <br /> $1,000,000 BID for each <br /> employee <br /> Limits for Coverage A- $1,000,000 BID policy limit Limits for Coverage A- <br /> Statutory State NC,for each Statutory State NC,for each <br /> employee The contractor shall provide employee <br /> and maintain, during the life of <br /> Limits for Coverage B- the contract, workers' Limits for Coverage B- <br /> Employers Liability of: Employers Liability of: <br /> $1 million Each Occurrence compensation insurance as $1 million Each Occurrence <br /> $1,000,000 BIDZ limit required by law, as well as $1,000,000 BID limit <br /> employer's liability coverage <br /> as noted below. <br /> Employer's Liability: Workers' <br /> Compensation is required if <br /> the contractor/vendor has <br /> employees. Owner Waiver is <br /> acceptable for a Sole <br /> Proprietor. <br /> Commercial General $1 million Each Occurrence <br /> Liability $1 million Each Occurrence $1 million Each Occurrence <br /> y $2 million Aggregate <br /> $2 million Aggregate $2 million Aggregate <br />