Certificate of Liability Insurance
You will need to provide a certificate of insurance naming the State of New York, the State University of New York and Farmingdale State College as additional insured (use Farmingdale State College’s address: 2350 Broadhollow Road, Farmingdale, NY 11735). We will need evidence of appropriate general liability insurance protection with limits of not less than one million ($1,000,000.00) each occurrence, and two million ($2,000,000.00) in the aggregate.
Proof of Worker's Compensations Insurance
Certificate of Workers’ Compensation Insurance
- Form C-105.2 (9/07) if coverage is provided by the contractor’s insurance carrier, contractor must request its carrier to send this form to Farmingdale State College
- Form U-26.3 if coverage is provided by the State Insurance Fund, contractor must request that the State Insurance Fund send this form to Farmingdale State College
- Form SI-12, Certificate of Workers’ Compensation Self-Insurance available from the New York State Workers’ Compensation Board’s Self-Insurance Office
- Form GSI-105.2, Certificate of Participation in Workers’ Compensation Group Self-Insurance available from the contractor’s Group Self-Insurance Administrator
Proof of Disability Insurance
- Form DB-120.1, Certificate of Disability Benefits Contractor must request its business insurance carrier to send this form to Farmingdale State College
- Form DB-155, Certificate of Disability Benefits Self-Insurance. The Contractor must call the Board’s Self-Insurance Office at 518-402-0247 to obtain this
Any event subject to Revocable Permit under Child Protection Policy
You will need to provide general liability insurance with two million dollars ($2,000,000.00) each occurrence and two million dollars ($2,000,000.00) in the aggregate; Sexual Abuse and Molestation insurance, either under the above described general liability policy or in a separate policy, with coverage not less than one million dollars ($1,000,000.00). Any insurance coverage for sexual abuse and molestation insurance written on a claims made basis shall remain in effect for a minimum of six (6) months following the use of University facilities.
Certificate of Attestation for New York entities with no employees and certain out of state entities (Form CE-200)
For groups that New York State Workers’ Compensation and/or Disability Benefits Insurance Coverage is not Required, please obtain a CE-200. This is available on the Workers’ Compensation Board’s website.
use of facilities
Horton Hall, Room 145
Use of Facilities Coordinator
Men's Basketball Coach/ Facility Contracts