2-Insurance Certificate.doc
DOC document 94 KB Posted
- Solicitation number
- ITB-26-00381
- Issued by
- Hillsborough County, Florida
About this file
This is a Certificate of Liability Insurance document issued for Hillsborough County, a political subdivision of the State of Florida. The certificate outlines the insurance requirements and coverage details that contractors must maintain when working on county projects. The document serves as proof that the insured contractor carries adequate liability coverage and has agreed to maintain that coverage without cancellation or reduction for a minimum of 30 days following written notice to the certificate holder. The certificate requires that Hillsborough County Board of County Commissioners Risk Management Division, located at 601 E. Kennedy Boulevard, 26th Floor, Tampa, Florida 33602, be named as an additional insured on all general, automobile, and aircraft liability policies. The certificate also requires that general liability policies include a separation of insureds provision, ensuring coverage applies independently to each insured party.
The certificate template establishes minimum insurance requirements across multiple categories, including commercial general liability, automobile liability, garage liability, excess liability, and workers' compensation and employer's liability coverage. Contractors must specify policy numbers, effective dates, expiration dates, and coverage limits for each insurance type. The general liability coverage must include limits for fire damage, personal and advertising injury, general aggregate, and products-completed operations aggregate. Automobile liability coverage must include combined single limits or separate limits for bodily injury and property damage, with options for any auto, owned autos, scheduled autos, hired autos, and non-owned autos. This insurance requirement applies to the Cablecast Broadcast and Streaming System Upgrade project for Hillsborough Television, which carries an estimated value of $56,845.00 and involves furnishing, installing, integrating, and commissioning a complete broadcast, streaming, and over-the-top system for a three-year contract period.
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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 .