Certificate of Insurance Required. Contractor shall furnish a current Certificate of Insurance to the County with the signed Contract. Contractor shall notify the County in writing at least 30 days in advance of any cancellation, termination, material change, or reduction of limits of the insurance coverage. The Certificate shall also state the deductible or, if applicable, the self-insured retention level. Contractor shall be responsible for any deductible or self-insured retention. If requested, complete copies of insurance policies shall be provided to the County. Risk Management review Date EXHIBIT 3 DESCHUTES COUNTY SERVICES CONTRACT Contract No. 20 - CERTIFICATION STATEMENT FOR CORPORATION OR INDEPENDENT CONTRACTOR NOTE: Contractor Shall Complete A or B in addition to C below: I certify under penalty of perjury that Contractor is a [check one]: Corporation Limited Liability Company Partnership authorized to do business in the State of Oregon. Signature Title Date
Certificate of Insurance Required. Contractor shall furnish a current Certificate of Insurance to the County. Contractor shall provide renewal Certificates of Insurance upon expiration of any of the required insurance coverages. Contractor shall immediately notify the County of any change in insurance coverage. The Certificate shall also state the deductible or retention level. The County must be listed as an Additional Insured by Endorsement on any General Liability Policy on a primary and non-contributory basis. Such coverage will specifically include products and completed operations coverage. The Certificate of Insurance shall state the following in the description of operations: “Additional Insured Form (include form number) attached. This form is subject to policy terms, conditions and exclusions.” A copy of the additional insured endorsement shall be attached to the Certificate of Insurance required by this Contract. Complete copies of insurance policies shall be provided to the County via MMP Supplier Portal located here: xxxxx://xxxxxxxxx.xxxxxxxx.xxx/apps/Router/SupplierLogin?CustOrg=Multnomah. If you need further assistance please email: xxxxxxxxxxxxxxxxxxxxx@xxxxxx.xx. The Certificate of Insurance should list Multnomah County as Certificate holder: Multnomah County Risk Management, 000 XX Xxxxxxxxx Blvd, Suite 400, Portland, OR 97214 EXHIBIT 0 XXXXXXXXX XXXXXX XXXXXXXX Xxxxxxxx Xx. XXX-XXXXXXX-00000-0000 Certification Statement for Corporation or Independent Contractor Contractor Must Complete A AND B below: Not valid unless signed.
Certificate of Insurance Required. Contact your Homeowners Insurance Company/Special Event Insurance and ask for a Certificate of Insurance in the amount of $1,000,000 which names The Islands Community Association and FirstService Residential as an “additionally insured” for the date of your event. TO BE NAMED AS ADDITIONALLY INSURED ON CERTIFICATE: The Islands Community Association, 000 X Xxxxxxx Xxxxx Xxxx, Xxxxxxx XX 00000 FirstService Residential, 0000 X. Xxxx Xxxxxx Xxxx. Xxx 000 Xxxxxxxxxx, XX 00000 INITIAL
Certificate of Insurance Required. A certificate of insurance acceptable to City must be provided prior to final execution of this Contract. Any certificate of insurance provided to City shall accurately state that the issued insurance policies meet the requirements outlined below and must be an original certificate issued by a company licensed to do business in the State of Wisconsin or signed by an agent licensed by the State of Wisconsin. Contractor shall send City a current and valid Certificate of Insurance and/or Policy within fourteen (14) days of any request by City. Immediately upon any material change to Contractor’s insurance coverage, Contractor shall send City an updated Certificate of Insurance and/or Policy.
Certificate of Insurance Required. Contractor shall furnish a current Certificate of Insurance to the County. Contractor shall provide renewal Certificates of Insurance upon expiration of any of the required insurance coverages. Contractor shall immediately notify the County of any change in insurance coverage. The Certificate shall also state the deductible or retention level. The County must be listed as an Additional Insured by Endorsement on any General Liability Policy on a primary and non-contributory basis. Such coverage will specifically include products and completed operations coverage. The Certificate shall state the following in the description of operations: “Additional Insured Form (include form number) attached. This form is subject to policy terms, conditions and exclusions.” A copy of the additional insured endorsement shall be attached to the certificate of insurance required by this contract. If requested, complete copies of insurance policies shall be provided to the County. Certificate holder should be: Multnomah County Risk Management, 000 XX Xxxxxxxxx Blvd. Suite 400, Portland, OR 97214. Where in the County to send your Certificate of Insurance. Risk Management has an email address that all insurance certificates should be sent to: xxxxxxxxx@xxxxxx.xx. Additional originals, hard copies, or faxes are not necessary. **Note to Contract Originator: Additional insurance may be required for certain types of contracts. Refer to the Contract Insurance and Indemnification Manual or contact Risk Management/Property & Liability Programs. Coverage limits may be modified to higher levels, based upon the needs of the contract without Risk Management review but any lower levels of coverage must be approved by Risk Management. Completed by: Xxxxxxx Xxxxx Contract Originator EXHIBIT 3 MULTNOMAH COUNTY SERVICES CONTRACT Contract No. 5600002522 Certification Statement for Corporation or Independent Contractor NOTE: Contractor Must Complete A or B below:
Certificate of Insurance Required. Contractor shall furnish a current Certificate of Insurance to the County with the signed Contract. Contractor shall notify the County in writing at least 30 days in advance of any cancellation, termination, material change, or reduction of limits of the insurance coverage. The Certificate shall also state the deductible or, if applicable, the self-insured retention level. Contractor shall be responsible for any deductible or self-insured retention. If requested, complete copies of insurance policies shall be provided to the County. Any violation by Contractor of this Certificate of Insurance provision shall, at the election of County, constitute a material breach of the Contract. EXHIBIT D DESCHUTES COUNTY SERVICES CONTRACT Contract No. 2023-546 CERTIFICATION STATEMENT FOR CORPORATION OR INDEPENDENT CONTRACTOR NOTE: Contractor Shall Complete A or B in addition to C below: A. CONTRACTOR IS A CORPORATION, LIMITED LIABILITY COMPANY OR A PARTNERSHIP. I certify under penalty of perjury that Contractor is a [check one]: ☒ Corporation 🗌 Limited Liability Company 🗌 Partnership authorized to do business in the State of Oregon.
Certificate of Insurance Required. Contractor shall furnish a current Certificate of Insurance to the County with the signed Contract. Contractor shall notify the County in writing at least 30 days in advance of any cancellation, termination, material change, or reduction of limits of the insurance coverage. The Certificate shall also state the deductible or, if applicable, the self-insured retention level. Contractor shall be responsible for any deductible or self-insured retention. If requested, complete copies of insurance policies shall be provided to the County.
Certificate of Insurance Required. Contractor shall furnish a current Certificate of Insurance to the City with the signed Contract. The Certificate shall provide that there shall be no cancellation, termination, material change, or reduction of limits of the insurance coverage without at least 30 days written notice from the Contractor’s insurer to the City. The Certificate shall also state the deductible or, if applicable, the self-insured retention level. No contract shall be effective until the required certificates have been received and approved by the City of Xxxxxxx. The certificate will specify and document all provisions within this contract. A renewal certificate will be sent to the City of Xxxxxxx 10 days prior to coverage expiration. For commercial general liability coverage, the Certificate shall also provide, by policy endorsement, that The City of Xxxxxxx, its agents, directors, officers, employees and volunteers are additional insureds with respect to Contractor’s services provided under this Contract. The endorsement must provide primary and non-contributory coverage. All endorsements must be in a format acceptable to The City of Xxxxxxx. Insurance Carrier Acceptability: Insurance coverage provided to the City of Xxxxxxx by the contractor will be in an acceptable form and underwritten by an insurance company deemed acceptable by the City of Xxxxxxx. The City of Xxxxxxx reserves the right to reject all or any insurance carrier(s) with an unacceptable financial rating. The City of Xxxxxxx has the sole authority and discretion to determine the acceptability of an insurance carrier's financial rating and the form of policies and endorsements. SAMPLE If requested, complete copies of the contractor’s insurance policies shall be provided to the City. All bonds will be in a format acceptable to the City and be provided by a company authorized to do business in Oregon. PUBLIC WORKS BOND – 279C.836 requires that all independent contractors working on qualifying public works projects, with a total project cost that exceeds $100,000 must obtain and file with the Construction Contractors Board (CCB) a public works bond with a corporate surety authorized to do business in Oregon for the amount of $30,000 before starting work on a contract or subcontract for a public works project. PUBLIC WORKS BOND ☑ Required by City BID BOND- 5% of total bid. ☑ Required by City PERFORMANCE BOND- In the amount of the awarded contract. ☑ Required by City PAYMENT BOND - In the amount of the awarded contra...
Certificate of Insurance Required. Contractor shall furnish a current Certificate of Insurance to the County with the signed Contract. Contractor shall notify the County in writing at least 30 days in advance of any cancellation, termination, material change, or reduction of limits of the insurance coverage. The Certificate shall also state the deductible or, if applicable, the self-insured retention level. Contractor shall be responsible for any deductible or self-insured retention. If requested, complete copies of insurance policies shall be provided to the County. Any violation by Contractor of this Certificate of Insurance provision shall, at the election of County, constitute a material breach of the Contract. Risk Management review Date EXHIBIT D DESCHUTES COUNTY SERVICES CONTRACT Contract No. 2022-795 CERTIFICATION STATEMENT FOR CORPORATION OR INDEPENDENT CONTRACTOR NOTE: Contractor Shall Complete A or B in addition to C below:
Certificate of Insurance Required. Contractor shall furnish a current Certificate of Insurance to the County with the signed Contract. Contractor shall notify the County in writing at least 30 days in advance of any cancellation, termination, material change, or reduction of limits of the insurance coverage. The Certificate shall also state the deductible or, if applicable, the self-insured retention level. Contractor shall be responsible for any deductible or self-insured retention. If requested, complete copies of insurance policies shall be provided to the County. Risk Management review Date ____________________________________ ___________________ EXHIBIT 3 DESCHUTES COUNTY SERVICES CONTRACT Contract No. 20__- CERTIFICATION STATEMENT FOR CORPORATION OR INDEPENDENT CONTRACTOR NOTE: Contractor Shall Complete A or B in addition to C below: CONTRACTOR IS A CORPORATION, LIMITED LIABILITY COMPANY OR A PARTNERSHIP. I certify under penalty of perjury that Contractor is a [check one]: Corporation Limited Liability Company Partnership authorized to do business in the State of Oregon. _______________________________________ ____________________ ____________ Signature Title Date CONTRACTOR IS A SOLE PROPRIETOR WORKING AS AN INDEPENDENT CONTRACTOR. Contractor certifies under penalty of perjury that the following statements are true:
