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Docusign Envelope ID: A13158799-C7BC-4838-B581-OC84CDE50697 <br />�I <br />City of Pembroke Pines <br />The City of Pembroke Pines must be shown as an additional insured with respect to <br />this coverage. The CITY's additional insured status shall extend to any coverage <br />beyond the minimum limits of liability found herein. <br />Yes No <br />✓ ❑ 2.6.2 Workers' Compensation and Employers' Liability Insurance covering all <br />employees, and/or volunteers of the CONTRACTOR engaged in the performance of the <br />scope of work associated with this Agreement. In the case any work is sublet, the <br />CONTRACTOR shall require the subcontractors similarly to provide Workers' <br />Compensation Insurance for all the latter's employees unless such employees are covered <br />by the protection afforded by the CONTRACTOR. Coverage for the CONTRACTOR and <br />all subcontractors shall be in accordance with applicable state and/or federal laws that may <br />apply to Workers' Compensation Insurance with limits of liability no less than: <br />1. Workers' Compensation: Coverage A — Statutory <br />2. Employers Liability: Coverage B $500,000 Each Accident <br />$500,000 Disease — Policy Limit <br />$500,000 Disease — Each Employee <br />If CONTRACTOR claims to be exempt from this requirement, CONTRACTOR shall <br />provide CITY proof of such exemption along with a written request for CITY to exempt <br />CONTRACTOR, written on CONTRACTOR letterhead. <br />Yes No <br />✓ ❑ 2.6.3 Comprehensive Auto Liability Insurance covering all owned, non -owned and hired <br />vehicles used in connection with the performance of work under this Agreement, with a <br />combined single limit of liability for bodily injury and property damage no less than: <br />1. Any Auto (Symbol 1) <br />Combined Single Limit (Each Accident) - $1,000,000 <br />2. Hired Autos (Symbol 8) <br />Combined Single Limit (Each Accident) - $1,000,000 <br />3. Non -Owned Autos (Symbol 9) <br />Combined Single Limit (Each Accident) - $1,000,000 <br />If work under this Agreement includes transportation of hazardous materials, policy shall <br />include pollution liability coverage equivalent to that provided by the latest version of the <br />ISO pollution liability broadened endorsement for auto and the latest version of the ISO <br />Motor Carrier Act endorsement, equivalents or broader language. <br />Yes No <br />❑ ❑ 2.6.3.1 If CONTRACTOR requests reduced limits under a Personal Auto Liability <br />Policy and it is agreed to by the CITY, coverage shall include Bodily Injury limits of <br />RFP # RE-24-04 SECTION 2 - INSURANCE REQUIREMENTS Page 22 <br />