'107-06 INSURANCE

June 2010 New York State Department of Transportation Page 1

I. GENERAL The Contractor is required, by New York State law, to maintain Worker’s Compensation, Disability, and Commercial Auto (when required) insurance until final acceptance of the work. The Department requires Commercial General Liability, Umbrella or Excess Liability, and Special Protective and Highway Liability from Contractors to protect the State from liability. The Department may also specifically require Builder’s Risk, Professional Liability, and/or Railroad Protective Liability insurance on some contracts, as indicated in the contract documents. The Contractor must have insurance coverage before starting any work on the contract site. The requirements concerning insurance coverage are critical for the protection of the State from liability. This matter should be given high priority during pre-construction meetings. It is imperative that contractors do not work on the right of way if their insurance expires at anytime before contract final acceptance. A. CERTIFICATE OF INSURANCE During the award process the Contractor provides the Contract Management Bureau with a copy of a certificate of insurance completed by their insurance company/agent. The certificate of insurance is received and stamped by the Contract Management Bureau, indicating its acceptability, and a copy is sent to the Region. Should modifications or corrections be required, a copy of the notification from Contract Management Bureau to the Contractor will be sent to the Region. If the certificate of insurance has not been accepted by the Contract Management Bureau prior to contract award, the Contractor will be informed in the award notification letter. Workers' Compensation (Exhibit 107-06A) and Disability Benefits (Exhibit 107-06B) insurance notices are provided to the contractor by their insurance company. B. VERIFICATION The Regional Construction Group shall determine whether a Contractor has a certificate of insurance on file with the Contract Management Bureau prior to allowing the Contractor to disturb the contract site. In the event any questions arise as to the status of a particular Contractor's insurance, a telephone inquiry should be made directly to the Contract Management Bureau. C. START OF WORK A Contractor shall not be allowed to create any disturbance within the right of way prior to contract award. If a contractor’s employee is injured within the right of way prior to award, the State is exposed to liability without insurance coverage by the Contractor. If a contractor elects to voluntarily start work prior to award they do so entirely at their own risk as described in the 6th paragraph of §102-17 Sample Form of Itemized Proposal/Jurat. A Contractor may begin to complete paperwork submittals, make arrangements for an Engineer’s Field Office or establish a Contractor’s office/yard outside the right of way, and coordinate material submittals, but must not be allowed to perform any work within the right of way. No approvals can be issued until after contract award. D. NOTIFICATION OF INSURANCE EXPIRATION DATE The Contract Management Bureau will notify the Contractor three (3) weeks before the expiration date of the insurance that the insurance will expire unless renewed, that the Contractor will not be allowed to work without insurance, and that the renewed policy should be forwarded to the Contract Management Bureau before the expiration date. The Contract Management Bureau will send a copy of this notice to the Region. The Region may assume, unless otherwise notified by the Contract Management Bureau, that the Contractor has provided the Contract Management Bureau with a new acceptable policy and that the Contractor is properly insured on the expiration date of the old policy.

Contract Administration Manual

'107-06 INSURANCE

June 2010 New York State Department of Transportation Page 2 Contract Administration Manual

II. SUBCONTRACTOR INSURANCE Each Subcontractor is required, by New York State law, to maintain Worker’s Compensation, and Disability, and Commercial Auto (when required) insurance. The Department also requires Commercial General Liability and Professional Liability Insurance from Subcontractors to protect the State from liability. Commercial Auto insurance is required if the Subcontractor has licensed vehicles involved in performing the work, not including vehicles used to transport workers to and from the site. Professional Liability insurance is only required for subcontractors that perform work which requires the submittal of a document that requires the seal and signature of a licensed professional, such as a demolition or erection plan. A. SUBCONTRACTOR CERTIFICATE OF INSURANCE The Contractor must provide the EIC with a copy of a Form C 219R(x) Subcontractor Certificate of Insurance or an ACORD form completed by their insurance company or agent. B. VERIFICATION The EIC shall determine whether a Subcontractor has a certificate of insurance on file prior to allowing the Subcontractor to perform any on-site work. The EIC will review Form C219R(x) (the x in the Form number is the appropriate Region number). The form must be complete, including the following:

$ Correct Form used (the correct C219 version will have the correct Region and address) OR $ ACORD form and C 105 and DB 120 certificates

On the C-219 or ACORD: $ Correct Name of the Subcontractor, Description of Work and Contract number listed $ Policy number entered $ Effective Date / Expiration Date shows that the Subcontractor is currently covered $ Limits meet or exceed the required minimums

$ Name and Address of the Insurance Company listed $ Name and Address of the Subcontractor listed as the insured $ Agency Name and Address listed (if the subcontractor uses an agent) $ Form Signed

C. START OF WORK The Subcontractor must have insurance coverage before starting any work on the contract site. A Subcontractor shall not be allowed to perform any on-site work if a valid Subcontractor Certificate of Insurance is not on file with the EIC at the Engineer’s Field Office. III. INSURANCE CLAIMS Claims related to a construction contract submitted by the public shall be forwarded to the Contractor for consideration. The Contractor may respond to the claim directly or refer it to the appropriate insurance company. The Contractor/Insurance Company may not be obligated to pay the claim, but they must respond. The Department should be informed of the action taken.

EXHIBITS A Sample Form C 105 Workers Compensation Notice B Sample Form DB 120 Disability Benefits Notice C Sample Form C 219R(x) Subcontractor Certificate of Insurance D Sample ACORD Insurance form

June 2010 New York State Department of Transportation Exhibit 107-06A Contract Administration Manual

June 2010 New York State Department of Transportation Exhibit 107-06B Contract Administration Manual

C 219Rx (5/10)

June 2010 New York State Department of Transportation Exhibit 107-06C1 Contract Administration Manual

SUBCONTRACTOR CERTIFICATE OF INSURANCE Send Both Certificates to New York State Department of Transportation Region X Regional Construction Group 123 Main Street Region City, New York 12345 Name & Address of Insured Contractor: Subcontractor Name Goes Here 123 Main St Firm City, NY 14567

Additional Insured: (under items b and c)

Description of Work: May be taken from contract description, or may be more specific. Contract Number D123456: The subscribing insurance company, authorized to do business in the State of New York, certifies that insurance of the kinds and types and for limits of liability herein stated, covering the work described in the underlying contract herein identified, has been procured by and furnished on behalf of the insured and is in full force and effect for the period listed below. Kind of Insurance Policy Number

Insurer Effective Date Expiration Date Limits of Liability (in thousands)

Per Occurrence Aggregate (a)Workers’ Compensation and Disability.

12-3456789 3/1/2010 2/28/2011 Statutory

Statutory

(b) Commercial General Liability. 78-123456 3/1/2010 2/28/2011 $1,000 $2,000

Additional Insured Endorsement (identify ISO form or attach copy of endorsement).

Endorsement:

Completed Operations (If provided under endorsement, identify ISO form or attach copy).

Endorsement:

Insured-administered deductible or Self-Insured Retention (SIR)* (state amount of SIR)

Deductible/SIR

Deductible/SIR

(c) Commercial Auto Liability Insurance. 45-6789ABC 1/1/10 12/31/10 $1,000

Insured-administered deductible or SIR* (state amount of SIR)

Deductible/SIR

Deductible/SIR

(d) Umbrella or Excess Liability Insurance.

(e) Special Protective and Highway Liability.

(f) Railroad Protective Liability Insurance.

(g) Professional Liability

Insured-administered deductible or SIR* (state amount of SIR)

Deductible/SIR

Deductible/SIR

(h) Builders’ Risks

Insured-administered deductible or SIR* (state amount of SIR)

Deductible/SIR

Deductible/SIR

(i) Other (describe)

* NYSDOT requires disclosure of deductibles and retention levels that are not pursuant to policy provisions, not bonded or otherwise collateralized.

C 219Rx REVERSE (5/10)

June 2010 New York State Department of Transportation Exhibit 107-06C2 Contract Administration Manual

This is to certify that America's Favorite Ins Co. (hereinafter called Company) of 1234 Pennsylvania Avenue, Washington, DC 23456 (Name of Insurance Company) (Home Office Address of Insurance Company) has issued to Subcontractor Name of 123 Main St, Firmcity, NY 14567 a policy or policies of insurance effective from (Name of Insured) (Address of Insured)

From the dates listed on the front of this certificate at 12:01 A.M. standard time at the address of the insured stated in said policy or policies and continuing until cancelled as provided herein to provide liability insurance covering the obligations imposed upon such contractor by the provisions of the laws of the State of New York, regulations promulgated therewith and the terms and provisions of Contract D 123456.

Such insurance as is herein certified (1) applies to all operations of said insured in connection with the work required by the provisions of the documents forming the contract, (2) applies on the effective date stated above, whether or not the contract documents between the insured contractor and the New York State Department of Transportation have been executed, and (3) is written in accordance with the company’s regular policies and endorsements, subject to the company’s applicable manuals or rules and rates, in effect, and the insurance provisions of the contract.

This Certificate is furnished in accordance with the specifications of the New York State Department of Transportation

applicable to NYSDOT’s contract with the Named Insured and covering the operations therein described.

These certificates described herein may not be cancelled without cancellation of a policy to which it is attached. Such cancellation may be issued by the company or the insured giving thirty (30) days’ notice in writing is actually received in the office of the New York State Department of Transportation, Regional Construction Group, Region 1, 328 State Street, Schenectady, New York 12305. No policy referred to herein shall be changed, cancelled or coverage terminated for any reason including expiration of the policy or nonpayment of premiums until thirty (30) days written notice has been received by the Director. Such notice shall be mailed via certified mail or registered mail.

Policy coverage MUST agree with coverage stated on this Certificate. False statements of coverage are punishable

under Section 2110 of the New York State Insurance Law.

America's Favorite Insurance Co

_____________________________________________________

1234 Pennsylvania Avenue _____________________________________________________

Washington DC, 23456 _____________________________________________________

_____________________________________________________

(Name and Address of Insurance Company)

By: _______________________________________________ (Signature of Authorized Representative) RUBBER STAMP NOT ACCEPTABLE

Dated: ________________________ Agency Name and Address:

Dated: _______________________ Telephone Number:

June 2010 New York State Department of Transportation Exhibit 107-06D Contract Administration Manual