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FIELD DOCUMENTS_FILE 2
EnvironmentalHealth
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3500 - Local Oversight Program
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PR0545028
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FIELD DOCUMENTS_FILE 2
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Last modified
12/6/2019 5:08:09 PM
Creation date
12/6/2019 2:54:13 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
FileName_PostFix
FILE 2
RECORD_ID
PR0545028
PE
3528
FACILITY_ID
FA0003919
FACILITY_NAME
VAN DE POL ENTERPRISES
STREET_NUMBER
5491
STREET_NAME
F
STREET_TYPE
ST
City
BANTA
Zip
95304
CURRENT_STATUS
02
SITE_LOCATION
5491 F ST
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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ROE 920316-INS A-1 <br /> Fomi Approved,AVP-Law <br /> If Workers Compensation insurance will not cover the liability of Licensee in states that require <br /> participation in state workers'compensation fund, Licensee shall comply with the laws of such <br /> states. If Licensee is self-Insured,evidence of state approval must be provided along with <br /> evidence of excess workers compensation coverage. Coverage shall include liability arising out of <br /> the U. S. Longshoremen's and Harbor Workers' Act, the Jones Act, and the Outer Continental <br /> Shelf Land Act, if applicable. <br /> The policy shall also contain the following endorsement which shall be indicated on the <br /> certificate of insurance: <br /> • Alternate Employer Endorsement <br /> D Umbrella or Excess Policies In the event Licensee utilizes Umbrella or excess policies, these <br /> policies shall "follow form" and afford no less coverage than the primary policy. <br /> E Railroad Protective Liability insurance naming only the Railroad as the insured with it <br /> combined single limit of $2,000,000 per occurrence with a $6,000,000 aggregate. The policy <br /> shall be broad form coverage for"Physical Damage to Property" (ISO Form CG 00 35 07 98 or <br /> equivalent). A binder stating the policy is in place must be submitted to the Railroad until the <br /> original policy is forwarded to the Railroad. <br /> Other Requirements <br /> F. Punitive damage exclusion must be deleted, which deletion shall be indicated on the certificate <br /> of insurance. <br /> G. Licensee agrees to waive its right of recovery, and its insurers, through policy endorsement, agree <br /> to waive their right of subrogation against Railroad. Licensee further waives its right of recovery, <br /> and its insurers also waive their right of subrogation against Railroad for loss of its owned or <br /> leased property or property under its care, custody and control. Licensee's insurance shall be <br /> primary with respect to any insurance carried by Railroad. All waivers of subrogation shall be <br /> indicated on the certificate of insurance. <br /> H. All policy(ies) required above (excluding Workers Compensation) shall provide severability of <br /> interests and shall name Railroad as an additional insured. Severability of interest and naming <br /> Railroad as additional insured shall be indicated on the certificate of insurance. <br /> I. Prior to commencing the Work, Licensee shall furnish to Railroad original certificate(s) of <br /> insurance evidencing the required coverage, endorsements, and amendments. The certificate(s) <br /> shall contain a provision that obligates the insurance company(ies) issuing such policy(les) to <br /> notify Railroad in writing of any cancellation or material alteration. Upon request from <br /> Railroad,a certified duplicate original of any required policy shall be furnished. <br /> J. Any insurance policy shall be written by a reputable insurance company acceptable to Railroad or <br /> with a current Best's Insurance Guide Rating of A- and Class VII or better, and authorized to do <br /> business in the state(s) in which the service is to be provided. <br /> K. Licensee WARRANTS that this Agreement has been thoroughly reviewed by Licensee's <br /> insurance agent(s)/broker(s), who have been instructed by Licensee to procure the insurance <br /> coverage required by this Agreement and acknowledges that Licensees insurance coverage will <br /> be primary. <br /> Exhibit A-t <br />
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