Common use of Certificate of Insurance Required Clause in Contracts

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 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 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 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 - 2016-### 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 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 - 2016-### 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 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 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 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 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 - 2021-998 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