Summary of Vendor Insurance Requirements

1. Provide ACORD Certificate of Insurance Form.

Certificate Holder Information:
Monroe County
39 W. Main St., Room 200
Rochester, NY 14614
Attn: Dept. of Transportation, City Place Building

2. Provide the Following Insurance Coverages:

A. General Liability Insurance

1. $1 million per occurrence
2. $3 million aggregate
3. Name Monroe County as additional insured and provide additional insured endorsement showing same (NOTE: ACORD Form alone is INSUFFICIENT for additional insured proof)
4. If aggregate coverage is less than $3 million:
   1. excess or umbrella coverage in an amount to provide $3 million total
   2. excess/umbrella coverage must name Monroe County as additional insured and provide additional insured endorsement showing same
5. Name these entities as additional insureds along with Monroe County as appropriate: Monroe County Department of Transportation
6. Name other entities (such as NYS or grant funders) as additional insureds if required by statute or grant agreement

B. Professional Liability Insurance (if applicable) (not applicable for permits)

1. $1 million per occurrence
2. $3 million aggregate
3. DO NOT name Monroe County as additional insured

C. Automobile Liability Insurance

1. $1 million per occurrence for bodily injury and property damage
2. Name Monroe County as additional insured and provide additional insured endorsement showing same (NOTE: ACORD Form alone is INSUFFICIENT for additional insured proof)

D. Workers Compensation Insurance (obtain forms from NYS Workers Comp website, www.wcb.ny.gov) Provide one of these certificates, depending upon vendor's business and employees:

1. C-105.2 (or U-26.3)
2. SI-12 (or GSI 105.2)
3. CE-200

NOTE: ACORD Form alone is INSUFFICIENT

E. Disability Benefits Insurance (obtain from www.wcb.ny.gov). Provide one of these certificates, depending upon type of coverage:

1. DB-120.1
2. DB-155
3. CE-200

NOTE: ACORD Form alone is INSUFFICIENT