Diocese of Rochester's Insurance Program
Contractors ~ Renters ~ Special Events ~Speakers
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Contractors Only- Certificate of Insurance Coverage/ Hold Harmless Agreement/ Workers Comp/ W-9
To comply with diocesan procedures, St. Maximilian Kolbe must obtain a Certificate of Insurance and a signed Hold Harmless Agreement from contractors prior to the commencement of work on parish property. See below.
The parish must obtain for the contractor and have on file the following:
1. A Certificate of Insurance with General Liability limits of $2,000,000 naming St. Maximilian Kolbe Catholic Church Society of Wayne County, the Diocese of Rochester and the Most Rev. Matthew H. Clark, Bishop of Rochester as Additional Insured; and
2. a signed Hold Harmless Agreement
3. Workers Comp Certificate
4. W-9
Contractors -Sample of Wordage for Certificate of Insurance Coverage
Contractors -Hold Harmless Agreement
Contractors -Click to download W-9 form
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Renters - Certificate of Insurance Coverage/ Hold Harmless Agreement/ Consumption Adult Beverage Form
To
comply with diocesan procedures, the Diocese of Rochester's Insurance
Program a Certificate of Insurance must be submitted to the Parish for
all events held at either St. Mary's of the
Lake / Church of the Epiphany / Mission of St. Rose of
Lima facilities.
All
usage of buildings and rooms require proof of insurance. You must
provide an insurance certificate showing St. Maximilian Kolbe Catholic
Church Society of Wayne County, The Roman Catholic Diocese of Rochester
and The Most Rev. Matthew H. Clark, Bishop of Rochester are included as
Additional Insured as Additional Insured for General Liability as
respects use of (Facility) on (Date) with a single limit of $1,000,000
dollars (one million). If your homeowner’s insurance does not carry that
limit, you may purchase a one time event insurance certificate by
filling an Insurance Program Special Events Coverage application and completing all timelines. You must provide to St. Maximilian Kolbe written proof of coverage within 15 days of the event.
If there will be consumptions of alcoholic beverages you must submit and sign the Consumption Adult Beverage Form
stating that adult beverages will be limited to those attendees over 21
years of age and that consumption by those less than 21 years of age
will be strictly prohibited. It will also be required that your purchase the Insurance Program Special Events Coverage.
Renters -Sample of Wordage for Certificate of Insurance Coverage
Special Events Coverage/ Consumption Adult Beverage/ Vendor Application Forms
A Consumption Adult Beverage Form needs to be purchased and fill out if Adult Beverages are served.
Speakers - Certificate of Insurance Coverage/ Hold Harmless/ W-9
To
comply with diocesan procedures, the Diocese of Rochester's Insurance
Program a Certificate of Insurance is recommended that these forms be submitted to the Parish for
all events held at either St. Mary's of the
Lake / Church of the Epiphany / Mission of St. Rose of
Lima facilities.
Speakers -Sample of Wordage for Certificate of Insurance Coverage
Speakers - Hold Harmless Agreement
Speakers - Click to download W-9 form
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