2-Insurance Certificate.doc
DOC document 94 KB Posted
- Solicitation number
- ITB-26-00072
- Issued by
- Hillsborough County, Florida
About this file
This is a Certificate of Liability Insurance form issued to Hillsborough County, a political subdivision of the State of Florida, by a producer certifying that insurance policies are in force for an insured party. The certificate documents various types of insurance coverage including general liability, automobile liability, garage liability, excess liability, and workers' compensation and employer's liability. The form indicates that Hillsborough County's BOCC Risk Management Division, located at 601 E. Kennedy Boulevard, 26th Floor, Tampa, FL 33602, has been named as an additional insured on the listed general, auto, and aircraft liability policies. The certificate includes checkboxes for various coverage options and limits, with notation that contractual liability coverage is included in the listed general and auto liability policies and that the general liability policies include a separation of insureds provision.
This insurance certificate is required in connection with the Cat Sterilization and Vaccination Certificate Program, a Hillsborough County Pet Resources Department initiative with an estimated project budget of $200,000. The program seeks licensed veterinarians with permitted veterinary establishments to provide spay, neuter, and vaccination services exclusively for stray cats and kittens taken in by Hillsborough County through the Pet Resources Center. Services are provided to homeless and unwanted cats in coordination with individuals or rescue groups registered with the PRD utilizing the certificate program, with feral and community cats explicitly excluded from program eligibility. The insurance requirements outlined in this certificate establish the minimum coverage necessary for participating veterinary providers to operate as partners in this county-funded animal welfare initiative.
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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 .