NYC 9111 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, andrndorsements must be sent
o the New York City Department of Environmental Protection, Agency Chief Contracting Officer,
¼TTN: 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 jurisdiction
II.B $1000.000 each accident
(x) Employers Liability: Section
II.D
() Jones Act:• Section
II.E
() U.S. Harbor Workers & Longshoreman .
Compensation Act:- Section
II:G -
• As respects use of tugs, barges or other marine operations under this
contract.
(X) Commercial General Liability CG 00 01 (ed.10/93) or $ f 000; 000 per occurrence:
equivalent. Combined Single Limit-Bodily Injury and $,; 5,000, Q00 products/completed operations aggregate
Property Damage: Section ILA $ 5 0_Q0, Q00 personal injury
0 000 00 general aggregate
$ 25,000 per claim maximum deductible, except as
approved by the CONTRACT MANAGEMENT OFFICE
Others to be added as additional Insureds: Additional Named Additional insureds
hsred status using ISO endorsement CG 2010.
Section 0 i rs of . Buildinga on Wh t ch we Tt Ts . Tn
v- - °c : I1. 3 Be Done
_.
r 5 't'\c.. .
11111 1~1y1 cr •rr rc.
(x)Business Auto Coverage: CA 00 01 (ed. 06/92) or
equivalent Combined Single Limit - Bodily Injury and
Properly Damage
(x) Owned (x) Hired (x) Non-Owned
The following coverage must be provided:
() Business Auto Coverage Form: Section III
PEP Form SCHED A SUPPLY & SERVICE: March 28,2002 (PINIf828WTCROOF1)
NYC-WTC 000115785
OCR can misread numbers and units. Confirm readings against the page image before using them.