NYC 9/11 Public Portal Document
SUPPLY and SERVICE CONTRACT Page 2 of 4
GENERAL CONDITIONS
SCHEDULE A
nsurance Indicated by (X) will be required under this contract. Insurance certificates, policies, and endorsements must be sent
o the New York City Department of Environmental Protection, Agency Chief Contracting Officer,
kTTN' Contract Management Office (INSURANCE), 17th Floor, 59-17 Junction Boulevard, Corona, New York 11368.
Article 6 of Agreement Insurance
(x) Workers Compensation: ' Section Statutory per New York State Law without regard to judsdlWmr
11.0 $1.000.00.0 each accident
(x) Employers Liability: Section
i1.D
() Jones Act:• Section
Il.E
{) U.S. Harbor W,torkers & Longshoreman '
Compensation Act ' Section
-11:G
' As respects use of tugs, barges or other marine operations wrier this
contract
(X) Commercial General Liability CG 00 01 (ed.10/93) or 0 U00 per occurrence:
$.5; . _QO
equivalent. Combined Single Limit-Bodily Injury and $ 51000,000 products/completed operations aggregate
Property Damage: Section IIA $' 5, 0_go, 000 personal injury
0 000 000 general.aggregate
$ 25,000 per claim maximum deductible, except as
approved by the CONTRACT MANAGEMENT OFFICE
4Z:, to::,added as additional Insureds: Additional
tu ing ISO endorsement CG 2010.
' ![:i~C3
Section
Named Additional Insureds
Othprs of Buildings on Which Wnr `Ts', Tn
Be- one
?ARK ROW R.t:14LV1 0
mtwk Co ... AC
).- CKy _____________________________
Cv Pow t,L- #-
$ 1.000.000 Each Occurrence
(x) Business Auto Coverage: CA 00 01 (ed. 06192) or
equivalent Combined Single Limit - Bodily injury and.
Property Damage
(x) Owned (x) Hired (x) Non-Owned
The following coverage must be provided:
() Business Auto Coverage Form: Section 11.I
DEP Form SCHED A SUPPLY & SERVICE: March 28, 2002 (PIN6826WTCROOFI)
NYC-WTC 000115730
OCR can misread numbers and units. Confirm readings against the page image before using them.