SAMPLE INSURANCE AGREEMENT - PROFESSIONAL HEALTH CARE CONSULTANTS

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Notwithstanding any terms, conditions or provisions, in any other writing between the parties, the consultant hereby agrees to effectuate the naming of the municipality as an additional insured on the consultants insurance polices, with the exception of workers' compensation, N.Y. tate !isability and professional liability. If the policy is written on a claims"made basis, the retroactive date must precede the date of the contract

II. #he policy naming the municipality as an additional insured shall$ % % % % % &urchase an insurance policy from an '.(. )est rated *secure* insurer, licensed in New York tate. tate that the organi+ation's coverage shall be primary and non"contributory coverage for the municipality, its )oard, employees and volunteers. #he municipality shall be listed as an additional insured by using endorsement ,- ./.0 or e1uivalent. ' completed copy of the endorsement must be attached to the certificate of insurance. #he certificate of insurance must describe the specific services provided by the contractor 2e.g., physical therapy, psychological services3 that are covered by the commercial general liability policy and the umbrella policy. 't the municipality's re1uest, the contractor shall provide a copy of the declaration page of the liability and umbrella policies with a list of endorsements and forms. If so re1uested, the contractor will provide a copy of the policy endorsements and forms.

III. #he consultant agrees to indemnify the municipality for any applicable deductibles and self" insured retentions. I4. 5e1uired Insurance$ % Commercial General Liability Ins rance (General Liability Insurance is required when services are being provided off-premises such as at the consultants office or clinic. 67,///,/// per occurrence8 6.,///,/// aggregate. !or"ers# Com$ensation an% N&'&S& (isability tatutory 9orkers' ,ompensation, :mployers' ;iability and N.Y. . !isability )enefits Insurance for all employees. &roof of coverage must be on the approved specific form, as re1uired by the New York tate 9orkers ,ompensation )oard. ',<5! certificates are not acceptable. ' self"employed person and certain partners and corporate officers are excluded from the definition of =employee> pursuant to 9orkers ,ompensation ;aw ection . 2?3. 's such, individuals in such capacity are excluded from 9orkers ,ompensation ;aw coverage re1uirements. ' person seeking an exemption must file a ,:".// form with the state. #he form may be completed and submitted directly online$ http$88www.wcb.state.ny.us8content8ebi+8wc@db@exemptions8re1uest:xemption<verview. Asp

Pro)essional Errors an% Omissions Ins rance 6.,///,/// per occurrence8 6.,///,/// aggregate for the professional acts of the consultant performed under the contract for the municipality. If written on a =claims"made> basis, the retroactive date must pre"date the inception of the contract or agreement. ,overage shall remain in effect for two years following the completion of work. E*cess Ins rance 67,///,/// each occurrence and aggregate. :xcess coverage shall be on a follow"form basis. 2!igher limits may be required depending on the type and si"e of the agreement and services.3 Per)ormance +on% ,O$tionalIf required# these bonds shall be provided by a $ew %or& 'tate admitted 'urety (ompany# in good standing. #he municipality shall be named as the obligee, and an original &ower of 'ttorney, ,orporate and urety 'cknowledgements must accompany the bond. ,onsultant acknowledges that failure to obtain such insurance on behalf of the municipality constitutes a material breach of contract. #he consultant is to provide the municipality with a certificate of insurance, evidencing the above re1uirements have been met, prior to the commencement of work or use of facilities. #he failure of the municipality to obAect to the contents of the certificate or the absence of same shall not be deemed a waiver of any and all rights held by the municipality. #he municipality is a member8owner of the NY (unicipal Insurance 5eciprocal 2NY(I53. #he consultant further acknowledges that the procurement of such insurance as re1uired herein is intended to benefit not only the municipality but also the NY(I5, as the municipality's insurer.

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