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CERTIFICATE OF INSURANCE EXHIBIT C <br />· . SERVICE CONTRACTS <br /> <br /> NOTE: No other certificate forms will be accepted. <br /> <br /> Please complete the following information: <br /> <br /> CONTRACTOR: <br /> Alameda County Sheriff's Department <br /> rnNT~arT T[RM: Conti'nuousr l~n]e~ f~rmina~ed Alameda County Agency or Oepartment <br /> at any time by either party for its convenience upon giving thirty (30) days' a~v~n~pwriften <br /> notice of such termination to the other party, unless sooner termj_nated by casualty. <br /> POLICY/BOND ENDORSEMENT REQUIREMENTS <br /> <br /> Contractor's policies or bonds shall be endorsed as follows: <br /> <br /> Name Alameda County, its Board of Supervisors, 'officers, agents and employees as <br /> Additional Insured/Obllqees with respect to services being provided, but County is not <br /> liable to the insurance company for any premiums, costs or assessments in connection <br /> with Contractor's policy/bond, as a .result of being an Additional Insured. <br /> <br /> Provide County 30 days advance written notice of cancellation, non-renewal or reduction <br /> in limits or coverage including the name of the Contract, mailed to the following <br /> address: <br /> <br /> Alameda County Sheriff's DepartmPnt T,iPnfpnanf: PlAnnina An~ Wp~p~rnh <br /> County Department to Receive Notice(s) Individual Coordlna{lng Contracts <br /> <br /> lPPq PAllnn ~frppf_ DrY~m 103; C)AklAn~_ ~liFnrniA qJ~lg-J3~! <br /> Address ' City, State, Zip <br /> <br /> State the Contractor's policy/bond is primary insurance to any other insurance available <br /> to County with respect to any claim arising out of this contract. <br /> <br /> Contractor is responsible for payment of insurance deductlbles. <br /> <br /> Insurance companies must have an "A.M. Best" rating of B+, ~ or better. <br /> <br /> REQUIRED COVERAGES - Where "X" Appears in Box CERTIFICATES OF INSURANCE ... <br /> <br /> /__X/l. Workers' Compensation <br /> Insurance Company(s) <br /> a. Statutory Compensation coverage. <br /> b. Employer's liability insurance with Policy Number(s) Policy Period(dates) <br /> limit not less than $10O,ODO per <br /> occurrence. Signature of Individual authorized <br /> by Insurance Company to bind Company <br /> to coverage shown, and above <br /> endorsement requirements. <br /> <br /> Name <br /> <br /> Address <br /> <br /> City, State, Zip <br /> <br /> <br />