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Docusign Envelope ID: E196FFB6-481D-48D1-A670-07B90011COBE <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 <br /> certificate holder and provide coverage for the duration of the funding period (two years, beginning as early as <br /> October 1, 2022). If proof of insurance can only be written for one year, an update will be required for all ongoing <br /> projects. 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 County. Please <br /> contact the staff identified on the Submission Requirements on Page 15 if you have questions or would like to <br /> request a review of your insurance requirements. <br /> APPENDIX <br /> Table 1. Forms of Liability Insurance and Minimum Policy Amounts Required <br /> INSURANCE ORANGE COUNTY3 300&� <br /> Worker's Compensation' Limits for Coverage A-Statutory State NC,for each <br /> employee <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 $1 million Each Occurrence <br /> Liability $2 million Aggregate <br /> Automobile Liability $1 million Each Occurrence <br /> Professional Liability $1 million Each Occurrence <br /> $2 million Aggregate <br /> Sexual Abuse& $1 million Each Occurrence <br /> Molestation $2 million Aggregate <br /> Cyber Liability $1 million Each Occurrence <br /> $2 million Aggregate <br /> Environmental/Pollution <br /> Liability <br /> (Required if demolition,use $1 million Each Occurrence <br /> of hazardous material or <br /> environmental) sensitive <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 /> Page 16 of 21 <br />