WA ST Dept of Commerce 10/15/2021

STATE OF WASHINGTON JUSTICE ASSISTANCE GRANT DEPARTMENT OF COMMERCE FORM 13 COMMERCIAL INSURANCE, RISK 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 15 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 this Grant SIGNATURE OF INDIVIDUAL WITH FUNCTIONAL RESPONSIBILITY TITLE OF OFFICIAL COMPLETING THE CERTIFICATION JURISDICTION/ORGANIZATION REPRESENTED DATE 33