Annual Backflow Tester Information and Certificate of Insurance

All persons performing backflow preventer tests in the City of Lincoln who wish to be on the Lincoln Water System list of approved Backflow Contractors must meet the following criteria:

  1. Annually provide a Certificate of Insurance that has City of Lincoln and/or Lincoln Water Systems as an additional insured under the General Liability Coverage. (This should be indicated on the Certificate of Liability Insurance under the Description of Operations/Locations/Vehicles/Exclusions Added by Endorsement/Special Provisions.)

    Example Certificate of Insurance and Additional Endorsement(, 0B)

    • 4.7 Certification and Registration of Technicians
      • 4.7.1 Persons performing inspections, tests and repairs of backflow prevention assembly(s), and persons conducting surveys and investigations of property or properties served by the Lincoln Water System for the purpose of backflow prevention compliance, shall be Registered Grade 6 Water Operators as defined by LMC Title 17. The Lincoln Water System will maintain a current list of registered Grade 6 Water Operators.
      • 4.7.2 Registered Grade 6 Water Operators must always maintain public liability insurance coverage for all claims arising out of all work in the City of Lincoln. Such insurance shall be commercial or comprehensive general liability policy, or an acceptable substitute as permitted by the City Attorney. The minimum combined single limit of $500,000.00 aggregate for any one occurrence on any job for which a permit is required under this code, provided the City of Lincoln shall be named an additional insured thereunder. The coverages required herein shall be subject to review and approval by the City Attorney for conformance with the provisions of this section.
  2. Annually provide a copy of CG 20 12 11 85 the Additional Insured-State or Political Subdivisions-Permits with the policy number on the endorsement, listing Lincoln Water System 2021 N 27th Street Lincoln NE 68503. Any endorsement referencing a written contract will be returned as the insured is NOT contracting with the City of Lincoln or Lincoln Water System to do work.
  3. The certificate of insurance must include verification that the general liability policy includes 30 days’ written notice of cancellation. In the event the certificate of insurance form does not provide a field to include this information, it can be identified in the Description of Operations section; by attaching a copy of the language in the policy; or providing a copy of the cancellation endorsement.
  4. The certificate must list the policy number for the general liability coverage and be signed by an authorized agent.
  5. Copy of Gauge Calibration Reports for all Calibration Devices
  6. Copy of Grade VI Tester Certificate and Renewal letter from DWEE

All items MUST be uploaded into the Backflow Tester Portal, Failure to provide all documents will result in removal from list of approved testers.

If you have any questions, please contact the Lincoln Water System Backflow Office at 402-441-5912 or email backflow@lincoln.ne.gov.

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