2-Insurance Certificate.doc
DOC document 94 KB Posted
- Attached to
- Mobile Welding Services
- Solicitation number
- ITB-26-00291
- Issued by
- Hillsborough County, Florida
About this file
This is a Certificate of Liability Insurance form for Hillsborough County, a political subdivision of the State of Florida, related to the Mobile Welding Services contract opportunity. The certificate documents insurance policies issued to a contractor providing mobile welding and fabrication services for the Hillsborough County Board of County Commissioners' Solid Waste Management Department. The services will be provided on an as-needed basis at South County Facility locations for equipment including roll-off containers, loaders, backhoes, excavators, stationary cranes, and other equipment, with the contract term ending July 31, 2028. The project has an estimated value of $207,429.10.
The certificate requires the contractor to maintain multiple types of insurance coverage, including General Liability, Automobile Liability, Workers' Compensation and Employer's Liability, and optionally Garage Liability and Excess Liability. Hillsborough County is named as an Additional Insured on the General, Auto, and Aircraft Liability Policies. All policies must include an endorsement requiring 30 days' written notice to the Certificate Holder at the Hillsborough County Risk Management Division (601 E. Kennedy Blvd, 26th FL, Tampa, FL 33602) before any cancellation or reduction in coverage. The contractor must specify policy numbers, effective and expiration dates, and coverage limits for each insurance type on the form.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 6-ITB-26-00291 Mobile Welding Services.pdf | ||
| 3-Substitute W9 Form.pdf.pdf | ||
| 1-Drug Free Workplace Form.doc | DOC document | |
| 5-ITB-26-00291 Insurance Requirements.pdf | ||
| 4-Direct Deposit Authorization Form 5.15.2025.pdf.pdf |
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Text version
CERTIFICATE OF LIABILITY INSURANCE
Date:
Producer, Address, Telephone No.
Insurers Affording Coverage
Insurer A:
Insurer B:
Insured, Address
Insurer C:
Insurer D:
Insurer E:
This is to certify that the insurance policies listed below have been issued to the insured and are in force at this time. It is further certified that these policies have been endorsed to provide that they will not be cancelled or changed so as to reduce the described coverages until 30 days after written notice of such cancellation or change has been delivered to the certificate holder at the address shown below.
Insr
Ltr
| Type of Insurance |
| Policy Number |
| Policy Effective Date |
| Policy Expiration Date |
| Limits |
| General Liability |
FORMCHECKBOX
Commercial General Liability
FORMCHECKBOX
Claims Made FORMCHECKBOX Occur
FORMCHECKBOX
FORMCHECKBOX
General Aggregate Limit Applies per:
FORMCHECKBOX
Policy FORMCHECKBOX Project FORMCHECKBOX Loc
| Each Occurrence |
| $ |
| Fire Damage |
| $ |
| Personal & Advertising Injury |
| $ |
| General Aggregate |
| $ |
| Products – Completed Operations Aggregate |
| $ |
| Automobile Liability |
FORMCHECKBOX
Any Auto
FORMCHECKBOX
All Owned Autos
FORMCHECKBOX
Scheduled Autos
FORMCHECKBOX
Hired Autos
FORMCHECKBOX
Non-Owned Autos
FORMCHECKBOX
FORMCHECKBOX
| Combined Single Limit (Each Accident) |
| $ |
Bodily Injury
(Per Person)
Bodily Injury
(Each Accident)
Property Damage
(Per Accident)
| Garage Liability |
FORMCHECKBOX
Any Auto
FORMCHECKBOX
| Auto Only – Ea Acc |
| $ |
Other than Ea Acc Auto Only:
Aggregate
| Excess Liability |
FORMCHECKBOX
Occur FORMCHECKBOX Claims Made
FORMCHECKBOX
Deductible
FORMCHECKBOX
Retention $
| Each Occurrence |
| $ |
| Aggregate |
| $ |
| Workers’ Compensation and |
Employer’s Liability
| FORMCHECKBOX |
WC Statu- FORMCHECKBOX Oth-tory Limits er
| E. L. Each Accident |
| $ |
| E. L. Disease – Ea Emp |
| $ |
| E. L. Disease – Pol Limit |
| $ |
| Other |
| $ |
FORMCHECKBOX
Contractual Liability Coverage is Included in listed General and Auto Liability Policies.
FORMCHECKBOX
“Hillsborough County, a political subdivision of the state of Florida” has been named as an Additional Insured on the listed General, Auto and Aircraft Liability Policies.
FORMCHECKBOX
Listed General Liability Policies include a Separation of Insureds (severability of interests) provision.
FORMCHECKBOX
Other Provisions/Limitations/Conditions:
Certificate Holder: Fax No. 813-635-8284 Hillsborough County - BOCC
Risk Management Division
601 E. Kennedy Blvd, 26th FL
Tampa, FL 33602 Authorized Representative:
Signature _____________________________________
ICM – 015 (09/10)
File details come from the government source that posted it. Updated .