2-Insurance Certificate.doc
DOC document 94 KB Posted
- Attached to
- Isotonic Sports Drinks
- Solicitation number
- ITB-26-00050
- Issued by
- Hillsborough County, Florida
About this file
This is a Certificate of Liability Insurance issued for a contract opportunity with the Hillsborough County Board of County Commissioners (BOCC) Fire Rescue Department in Florida. The certificate outlines the insurance requirements and coverage mandates that suppliers must maintain when providing isotonic sports drinks to Fire Rescue personnel for a two-year period. The contract has an estimated project budget of $102,850.00 and is intended to supply beverages that supplement fluid loss during firefighting and training operations. The certificate specifies that Hillsborough County, a political subdivision of the state of Florida, must be named as an Additional Insured on all General, Auto, and Aircraft Liability Policies, and that all policies maintain coverage with 30 days' written notice required prior to cancellation or modification of coverage.
The insurance certificate establishes mandatory coverage requirements across multiple liability categories, including General Liability with Commercial General Liability coverage, Automobile Liability for any autos, Workers' Compensation and Employer's Liability, and Excess Liability as applicable. The certificate holder is designated as the Hillsborough County BOCC Risk Management Division located at 601 E. Kennedy Blvd, 26th Floor, Tampa, FL 33602, with contact fax number 813-635-8284. The document requires contractual liability coverage to be included in listed General and Auto Liability Policies and mandates a Separation of Insureds provision in General Liability Policies. All specific policy limits, deductibles, and coverage amounts must be completed by the insurance provider at time of issuance to ensure full compliance with Hillsborough County's risk management requirements.
View the file
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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 .