2-Insurance Certificate.doc
DOC document 94 KB Posted
- Attached to
- Street Sweeping Services
- Solicitation number
- ITB-26-00408
- Issued by
- Hillsborough County, Florida
About this file
This is a Certificate of Liability Insurance template issued by Hillsborough County, a political subdivision of the State of Florida, through its Board of County Commissioners (BOCC) Risk Management Division. The certificate documents insurance policies required for contractors providing street sweeping services for designated Hillsborough County roadways and other county-maintained impervious surfaces, including parking lots and paved shoulders, over a two-year contract period with an estimated project value of $1,564,250.00. The certificate holder is identified as Hillsborough County - BOCC Risk Management Division, located at 601 E. Kennedy Boulevard, 26th Floor, Tampa, Florida 33602, with a fax number of 813-635-8284.
The certificate specifies required coverage types including General Liability, Automobile Liability, Garage Liability, Excess Liability, and Workers' Compensation and Employer's Liability insurance. The template indicates that Hillsborough County must be named as an Additional Insured on all listed General, Auto, and Aircraft Liability Policies. All policies are required to include a 30-day cancellation notice provision to protect the county's interests. Contractors are responsible for providing proof of contractual liability coverage and ensuring separation of insureds provisions are included in general liability policies. The certificate does not specify minimum coverage limits or deductible amounts within the document itself, suggesting these requirements are detailed in the underlying contract documents or solicitation materials.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 3-Substitute W9 Form.pdf.pdf | ||
| 6-ITB-26-00408 Street Sweeping Services.pdf | ||
| 9-ITB-26-00408 Addendum No. 1.pdf | ||
| 7-Street Sweeping Locations - Collector Roads.xlsx | XLSX spreadsheet | |
| 1-Drug Free Workplace Form.doc | DOC document | |
| 8-Street Sweeping Locations - Local Roads.xlsx | XLSX spreadsheet | |
| 10-ITB-26-00408 Current Contract Invoices.pdf | ||
| 5-ITB-26-00408 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 .