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. 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. 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=MultnomahPortal. If Please send copies to xxxxx://xxxxxx.xx/purchasing or email xxxxxxxxxxxxxxxxxxxxx@xxxxxx.xx if you need further assistance please email: xxxxxxxxxxxxxxxxxxxxx@xxxxxx.xxassistance. 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 Xx3 MULTNOM AH COUNTY P UBLIC WORKS AGREEME NT Contract No. XXX-XXXXXXX-00000-0000 [[ Contract Number ]] Certification Statement for Corporation or Independent Contractor SAMPLE NOTE: Contractor Must Complete A AND or B below: Not valid unless signed.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 Non-Profit Corporation 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 Xx3 M ULTNO M AH CO UNTY S ERVI C E S CO NT RACT Contract No. XXXXXXX-XXXXXXX-00000SVCSGEN-14425-0000 2023 Certification Statement for Corporation or Independent Contractor A. CONTRACTOR IS A CORPORATION, LIMITED LIABILITY COMPANY, OR A PARTNERSHIP. I certify under penalty of perjury that Contractor Must Complete A AND B below: Not valid unless signed.is a (check one): ☐ Corporation ☐ Limited Liability Company ☐ Partnership ☐ Non-Profit Corporation authorized to do business in the State of Oregon ☐ NOT APPLICABLE – See section B.

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 XxMUL T NOM AH C OUNT Y S ER V IC E S CONT RACT Contract No. XXX-XXXXXXX-00000-0000 [[ Contract Number ]] Certification Statement for Corporation or Independent Contractor NOTE: Contractor Must Complete A AND or B below: Not valid unless signed.signed 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 ☐ Non-Profit Corporation authorized to do business in the State of Oregon ☐ NOT APPLICABLE – See section B.

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=MultnomahPortal. If Please send copies to xxxxx://xxxxxx.xx/purchasing or email xxxxxxxxxxxxxxxxxxxxx@xxxxxx.xx if you need further assistance please email: xxxxxxxxxxxxxxxxxxxxx@xxxxxx.xxSAMPLE assistance. 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 Xx3 MULTNOMAH COUNTY SERVICES CONTRACT Contract No. XXX-XXXXXXX-00000-0000 [[ Contract Number ]] Certification Statement for Corporation or Independent Contractor Contractor Must Complete A AND or B below: SAMPLE Not valid unless signed.signed 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 ☐ Non-Profit Corporation authorized to do business in the State of Oregon ☐ NOT APPLICABLE – See section B.

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 XxM UL TNO M AH COUNT Y SE RVI CES CO NT R ACT Contract No. XXX-XXXXXXX-00000-0000 SAMPLE Certification Statement for Corporation or Independent Contractor NOTE: Contractor Must Complete A AND or B below: Not valid unless signed.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 ☐Non-Profit Corporation authorized to do business in the state of Oregon Signature: Title: Date: B. CONTRACTOR IS A SOLE PROPRIETOR WORKING AS AN INDEPENDENT CONTRACTOR. Contractor certifies under penalty of perjury, that the following statements are true:

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 Xx3 M UL TNO M AH COUNT Y SE RVI CES CO NT R ACT Contract No. XXX-XXXXXXX-00000-0000 Certification Statement for Corporation or Independent Contractor NOTE: Contractor Must Complete A AND or B below: Not valid unless signed.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 ☐Non-Profit Corporation authorized to do business in the state of Oregon Signature: Title: Date: B. CONTRACTOR IS A SOLE PROPRIETOR WORKING AS AN INDEPENDENT CONTRACTOR. Contractor certifies under penalty of perjury, that the following statements are true: