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Docusign Envelope ID: A13158799-C7BC-4838-B581-OC84CDE5OB97 <br />1, _ <br />"� ` `= City of Pembroke Pines <br />,y <br />CITY proof of such exemption for CITY to exempt CONTRACTOR. <br />Yes No <br />❑ ❑ 7.6.3 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 ISO <br />pollution liability broadened endorsement for auto and the latest version of the ISO Motor <br />Carrier Act endorsement, equivalents or broader language. <br />Yes No <br />❑ ❑ 7.6.3.1 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 />$100,000 per person/$300,000 per occurrence and Property Damage limits of <br />$300,000 per occurrence <br />Yes No <br />❑ ❑ 7.6.4 Umbrella/Excess Liability Insurance in the amount of $ as determined <br />appropriate by the CITY depending on the type of job and exposures contemplated. <br />Coverage must be follow form of the General Liability, Auto Liability and Employer's <br />Liability. This coverage shall be maintained for a period of no less than the later of three <br />(3) years after the delivery of goods/services or final payment pursuant to this Agreement. <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 />❑ ❑ 7.6.5 Professional Liability/Errors & Omissions Insurance with a limit of liability no less <br />than $1,000,000 per wrongful or negligent act. This coverage shall be maintained for a period <br />of no less than three (3) years after the delivery of goods/services final payment pursuant to <br />this Agreement. Retroactive date, if any, to be no later than the first day of service to the CITY. <br />(Limit to align with size and scope of the Agreement and exposure inherent with <br />operation/services being performed. For Construction projects: Increase to ten (10) years) <br />Yes No <br />❑ ❑ 7.6.6 Environmental/Pollution Liability insurance shall be required with a limit of no less <br />than $1,000,000 per wrongful act. Coverage shall include: CONTRACTOR's completed <br />operations, sudden, accidental and gradual pollution conditions. This coverage shall be <br />maintained for a period of no less than the later of three (3) years after the delivery of <br />goods/services or final payment pursuant to this Agreement. Retroactive date, if any, to be <br />no later than the first day of service to the CITY. (Limit to align with size and scope of the <br />Agreement and exposure inherent with operation/services being performed. For <br />Page 8 of 21 LR-2021-06 <br />