WORKERS COMPENSATION Policy number and period current (14) WC Statutory Limits box checked (15) Employers Liability Limits of $1,000,000 Each Accident, $1,000,000 Disease Each Employee, and $1,000,000 Disease Policy Limit (16) Waiver of subrogation endorsement in favor of certificate holder See Sample Endorsement – EXCESS LIABILITY (IF REQUIRED BY CONTRACT) Policy number and period current (17) Occurrence Form (18) Each Occurrence Limit / Aggregate Limit of (19) OTHER COVERAGE - (IF REQUIRED BY CONTRACT) Policy number and period current (20) Each Occurrence Limit / Aggregate Limit of (21) Double-click on icon below for sample certificate and endorsements:
WORKERS COMPENSATION Policy number and period current (14) WC Statutory Limits box checked (15) Employers Liability Limits of $1,000,000 Each Accident, $1,000,000 Disease Each Employee, and $1,000,000 Disease Policy Limit (16) Waiver of subrogation endorsement in favor of certificate holder – See Sample Endorsement EXCESS LIABILITY (IF REQUIRED BY CONTRACT) Policy number and period current (17) Occurrence Form (18) Each Occurrence Limit / Aggregate Limit of (19) OTHER COVERAGE - (IF REQUIRED BY CONTRACT) Policy number and period current (20) Each Occurrence Limit / Aggregate Limit of (21) Double-click on icon below for sample certificate and endorsements:
Subcontractor_Insurance_Reqs_Sample_Certificate.docx