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<br />Page 22 of 22 <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 /> <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 <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 /> <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 that if an <br />agency uses subcontractors, it must require subcontractors to have workmen’s compensation insurance. <br />▪ Please visit Orange County’s Risk Management page for more information about the County’s Minimum <br />Insurance Requirements. <br /> <br />Table 2 - Contact Information for Board of Directors and Officers of the Board <br />Name <br />(also title and term <br />length if Officer) <br />Physical <br />Address <br />Mailing <br />Address Phone number Email address Fax number (if <br />applicable) <br /> <br /> <br /> <br /> <br />Docusign Envelope ID: 61C3903E-05FE-49FE-A6AF-E50B7D61917E