2-Insurance Certificate.doc
DOC document 94 KB Posted
- Attached to
- Mosquito Control Spraying Services State and local contract opportunity
- Solicitation number
- ITB-26-00311
- Issued by
- Hillsborough County, Florida
About this file
This is a Certificate of Liability Insurance template prepared for Hillsborough County, a political subdivision of the State of Florida, in connection with the Mosquito Control Spraying Services contract opportunity. The certificate documents insurance policies issued to a contractor performing aerial and ground mosquito control spraying services for the County over a three-year period with an estimated project value of $2,756,360.00. The certificate holder is identified as Hillsborough County Board of County Commissioners (BOCC) Risk Management Division, located at 601 E. Kennedy Boulevard, 26th Floor, Tampa, Florida 33602.
The insurance requirements documented in the certificate include General Liability coverage with options for claims-made or occurrence-based policies, Automobile Liability coverage, Workers' Compensation and Employer's Liability insurance, and provisions for Contractual Liability coverage within the General and Auto Liability policies. The certificate specifies that Hillsborough County must be named as an Additional Insured on the listed General, Auto, and Aircraft Liability policies, and requires that all policies include a 30-day written notice provision before any cancellation or material change to coverage can occur. The document permits the contractor to select various coverage limits and aggregate limits on a per-policy or per-project basis, with fields for specific dollar amounts to be completed based on the County's insurance requirements. All listed General Liability policies must include a Separation of Insureds (severability of interests) provision.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| 5-ITB-26-00311 Insurance Requirements.pdf | ||
| 1-Drug Free Workplace Form.doc | DOC document | |
| 3-Substitute W9 Form.pdf.pdf | ||
| 4-Direct Deposit Authorization Form 5.15.2025.pdf.pdf | ||
| 6-ITB-26-00311 Mosquito Control Spraying Services.pdf |
On GovTribe
Work with this file on GovTribe
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .