This page is for informational purposes only.
Refer to the agreement for a complete list of contractual insurance requirements. Provide your insurance broker/agent with a copy of the requirements and request a Certificate of Insurance with the Additional Insured Endorsement. Proof of insurance must be provided prior to commencement of service.
Certificate of Insurance (see attached sample)
The Certificate of Insurance is a one-page document that summarizes essential information about an organization’s insurance coverage such as insurance carriers, types of coverage, policy numbers, limits of insurance, and policy effective and expiration dates. For breakdown of coverage limits refer to the agreement. The Certificate Holder should read as follow:
County of Santa Clara
P.O. Box 100085-ZB
Duluth, GA 30096
Additional Insured Endorsement (see attached example)
The County requires an Additional Insured Endorsement on a separate form from the certificate. An Additional Insured Endorsement is an addendum to formally add the County as a party to the insured policy. It is not sufficient to have the additional insured language in the description box. The name of Person or Organization should read as follow:
“County of Santa Clara, and members of the Board of Supervisors of the County of Santa Clara, and the officers, agents, and employees of the County of Santa Clara, individually and collectively”
Some insurance requirements may be satisfied in whole or in part by adequately funded self-insurance programs or self-insurance retentions. Any self-insurance must be approved in writing by County’s ESA Insurance Division.
Contracts Insurance Monitor(s)
The verification of coverage should be sent to the requesting County department, unless otherwise directed. The County utilizes the services of Ebix BPO, a third-party vendor, to monitor contractor insurance compliance. In some instances, both Ebix and the department will request proof of insurance. It is necessary to respond to both and give the matter immediate and careful attention as inadequate response may result in the suspension of work or the withholding of payment for services or goods. Please see below contact information.
Ebix BPO (formerly Periculum Services Group) at:
(517) 647-1700 x 205
Account Rep. e-mail: