HomeMy WebLinkAboutGrant Related - Sheriff & JailN
STATE OF WASHINGTON JUSTICE ASSISTANCE GRANT
DEPARTMENT OF COMAIERCE FORM 14
COMME RCLkL INSURANCE, FJSK POOL OR SELF INSURANCE
Cities and Counties receiving grant funds directly from Commerce under this program must have:
Automobile Liability. In the event that performance pursuant to this Agreement involves the use of
vehicles, owned or operated by the Contractor or Its Subcontractor, automobile liability insurance
shall be required. The minimum limit for automobile liability is $1,000,000 per occurrence, using a
Combined Single Limit for bodily injury and property damage,
Commercial General Liability Insurance Policy. Provide a Commercial General Liability Insurance
Policy, including contractual liability, written on an occurrence basis, in adequate quantity to protect
against legal liability arising out of Agreement activity but no less than $1 000,000 per occurrence,*
Additionally, the Contractor Is responsible for ensuring that any Subcontractors provide adequate
insurance coverage for the activities arising out of subcontracts.
Employers Liability, Insurance providing wage replacement and medical benefits to employees
injured in the course of employment, filling the gaps between Worker's Compensation and
Commercial General Liability.
Fidelity Insurance. The Contractor shall maintain insurance coverage at least equal to the awarded
funds under this agreement to protect against fraudulent acts by individuals authorized to receive or
deposit funds into program accounts, or to prepare or issue financial documents, checks, or other
instruments of payment for program costs,
Professional Liability, Errors and Omissions Insurance. The Contractor shall maintain
Professional Liability or Errors and Omissions Insurance. The Contractor shall maintain minimum
limits of no less than $1 000,000 per occurrence to cover all activities by the Contractor and licensed
staff employed or under contract to the Contractor. The state of Washington, its agents, officers, and
employees need not be named as additional insureds under this policy.
Worker's Compensation. Coverage of employees which in the course of employment incurred
bodily injury (including death) by accident or disease that arises out of or in connection with the
performance of the grant agreement.
The agency executing the grant award for this program shall provide insurance coverage as set forth
above. The intent of the required insurance is to protect the state should there be any claims, suits,
actions, costs, damages or expenses arising from any loss, or negligent or intentional act or omission of
the Grantee or Subgrantee/subcontractor, or agents of either, while performing under the terms of this
Grant.
The insurance required shall be issued by an insurance company or risk pool authorized to do business
within the state of Washington. Except for Professional Liability or Errors and Omissions Insurance, the
insurance shall name the state of Washington, its agents, officers, and employees as additional insureds
under the insurance policy. All policies shall be primary to any other valid and collectable insurance. The
Grantee shall instruct the insurers to give COMMERCE thirty (30) calendar days advance notice of any
insurance cancellation, non -renewal or modification,
The Grantee shall submit to COMMERCE, within 16 days of being requested, a certificate of insurance
which outlines the coverage and limits defined in this insurance section. Commerce will be named as an
additional insured on this certificate. During the term of the Grant, the Grantee shall submit renewal
certificates not less than thirty (30) calendar days prior to expiration of each policy required under this
section.
The Grantee shall provide insurance coverage that shall be maintained in full force and effect during the
term of his Grant
;3ne-ec CA& 0-
SIGNATURB OF DIVIDUAL WM4 FUNCTIONAL RFSPONSIBILITY TITLE OF OFFICIAL COMPLETINci THE CERTIFICATION
Glwwt 6a -n
JURISDICTTON/ORGANIZATIOREPRESENTED DATE
R E• C
27
NT C 0 UiNt "N C2, tiq