Insurance Requirement Assessment Tool Section 1 Name Email Agency Please use the full name of the agency. Budget Category - Select -Purchases / Competitive solicitations for goods and servicesGrantmaking / Subawards No further steps required for budgets under $30,000. Section 2 Automobile Will the vendor’s staff or volunteers be conducting site visits and or be transporting a population under the services procured by the State? Yes No Recommend minimum of $1,000,000 each occurrence combined single limit. No minimum recommended. General Liability Minimum of combined single limit of $1,000,000 per occurrence, $1,000,000 general aggregate and $1,000,000 products/completed operations aggregate. Workers’ Comp. Minimum: $100,000 each accident, $100,000 disease or policy limit and $100,000 each employee. Exemptions include: Sole proprietors, partners, and independent contractors. Certain real estate, agricultural and domestic service employees may be exempt. Please provide proof of coverage or how you qualify under the aforementioned exemption categories. Crime Will the vendor have access to funds or investments of any kind entrusted to or owned by the State? This question is for vendors who will oversee payments or client funds. Yes No Have minimum combined limits of not less than $500,000 per occurrence; however, in no instance shall the combined limits be less than fifty per cent (50%) of the value of the Contract or based on the amount of funds that may be diverted, whichever is greater. Name State as loss payee based on ISO CR20141010 or the equivalent. Does not contain a condition requiring an arrest. No minimum recommended. Professional Liability Is the vendor providing professional services including but not limited to: Architecture, Health-Related, Technological, Marketing/Public Relations, Accounting, Legal, Consultants, and Social Workers? Yes No Minimum: $2,000,000 per occurrence, $2,000,000 annual aggregate. No minimum recommended. PL: Medical / Provider Malpractice Coverage Will this vendor be providing a service that requires direct patient contact? Yes No Malpractice minimum: $1,000,000 per occurrence, $3,000,000 annual aggregate. No minimum recommended. Environmental / Pollution Will this vendor be managing environmental hazards or providing environmental remediation services? Yes No Recommend minimum of $1,000,000 per occurrence and $2,000,000 aggregate. No minimum recommended. Molestation and Abuse Would the vendor’s staff be in a situation where physical or mental abuse to the population would be possible? Yes No Recommend minimum of $1,000,000 per occurrence. No minimum recommended. Technology Errors and Omissions Will the vendor be providing a software solution to the State? Yes No Combined single limit per occurrence shall not be less than $5,000,000. Annual aggregate limit shall not be less than $5,000,000. No minimum needed. Information Technology Cybersecurity / Privacy Will the vendor (including subcontractors) be conducting all work involving information or data owned by the State within the State networks/systems exclusively? Yes No How many records containing confidential information (PHI, PII, etc .) will the vendor be handling? - Select -0 – 2,0002,001 – 5,0005,000+ Minimum limits of $1,000,000 per occurrence and $1,000,000 annual aggregate Minimum limits of $2,000,000 per occurrence and $2,000,000 annual aggregate Minimum limits of $5,000,000 per occurrence and $5,000,000 annual aggregate What is the importance of the project to state operations. i.e., what ramifications would there be if the vendor and/or its system is down for a day or more? - Select -Essential service will not be able to be provided for more than one day.Essential service will not be able to be provided for one day or less. Agency will still be able to provide the essential service regardless of the work involving the vendor. MINIMUM REQUIRED MINIMUM REQUIRED Minimum recommendation not changed from the above. Does the Contract Party provide key back office services? Yes No A minimum limit of $10,000,000 per occurrence and $10,000,000 annual aggregate Does Contract Party have access to confidential data or Personal Information as defined in in R.I. Gen. Laws § 11-49.3-1, et seq., or as otherwise defined in the Contract (together Confidential Information)? Yes No Contract Party shall have as a minimum the per occurrence, per annual aggregate, the total rounded product of projected number of persons data multiplied by $25 per person breach response expense per occurrence; but no less than $5,000,000 per occurrence, per annual aggregate; Does Contract Party provide or have access to mission critical services, network architecture and/or the totality of confidential data? Yes No $20,000,000 per occurrence and in the annual aggregate. Leave this field blank