ࡱ> 241 ubjbj 4"u      4444$X4.lllllGGGCEEEEEE$i GGGGGi  ll~G l lCGCl ]:/0>>4> \GGGGGGGiiGGGGGGG>GGGGGGGGG :  Certificate Request Letter (Date) RE: Diocese of Springfield Illinois and (Parish) Dear (Company Name) Please read this letter carefully. The information contained in this letter will affect whether or not you may enter into an agreement with us and may affect your receipt of prompt payment. Should you be chosen to perform work for the Diocese of Springfield Illinois, we require that you return to us a signed contract and a Certificate of Insurance issued to the Diocese and the parish or organization showing commercial general liability, business auto liability and employers liability (workers compensation) insurance. We require that you provide a copy of any endorsement issued by your insurance company naming The Diocese of Springfield in Illinois, and all subsidiaries, affiliates, institutions, and societies owned or operated by the Diocese and Catholic Charities are added as an additional insured on a primary and non contributory basis on the general liability and excess liability policy. The certificate must list the local parish/agencys location in the description of operations. Your insurance company/s must be rated A or better in the AM Best Rating Guide. The certificate holder must read: Diocese of Springfield in IL (Name of the Parish or Organization that you will be working for) 1615 W. Washington Street Springfield, IL 62702 We must receive these documents before you begin work or provide services. Payment for services will not be made until all documentation is received. Insurance Limits Required: General Liability- $1,000,000 Each Occurrence $1,000,000 Personal & Advertising Injury $2,000,000 General Aggregate $ 100,000 Damage to Rented Premise $2,000,000 Products Comp/Op Aggregate $ 5,000 Medical Payments - each person Business Automobile $1,000,000 Combined Single Limit - each accident $1,000,000 Hired Auto Liability $1,000,000 Non-Owned Auto Liability Employers Liability $1,000,000 Each Accident (Workers Compensation) $1,000,000 Disease each employee $1,000,000 Disease policy limit The Proprietor/Partner/Executive Officer/Member Excluded Box must be market Y or N Anyone who is excluded from this coverage, their name must be listed in the Description area of the certificate. If work is performed by any excluded person, they must sign a waiver provided by the Diocese. We also require a Waiver of Subrogation for Worker Compensation. A check mark may be entered next to the Workers Compensation under the Waiver of Subrogation Column; Or the following wording may be added: To the fullest extent permitted by applicable state law, a Waiver of Subrogation Clause shall be added to the Workers Compensation policy in favor of Diocese of Springfield in IL, and this clause shall apply to the Dioceses officers, agents, and employees with respect to all Projects during the policy term. Additionally we require at least 30 days written notice prior to cancellation or termination of your insurance policies. (Acceptable Alternative limits are general liability $1,000,000 each occurrence, $1,000,000 aggregate with a $1,000,000 excess or umbrella policy; Auto $500,000 combines single limit with a $1,000,000 excess or umbrella policy; Employers Liability(Work Comp) $500,000 with a $1,000,000 excess or umbrella policy that goes over employers liability part B.) 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