2-Insurance Certificate.doc
DOC document 94 KB Posted
- Attached to
- Appliance Maintenance and Repair Services
- Solicitation number
- ITB-26-00130
- Issued by
- Hillsborough County, Florida
About this file
This is a Certificate of Liability Insurance form related to Hillsborough County's competitive sealed bid solicitation for Appliance Maintenance and Repair Services. The document serves as a template for contractors bidding on the installation, repair, and routine annual preventative maintenance services for commercial-grade ranges and other appliances at Fire Rescue Stations throughout Hillsborough County. The resulting contract is for a two-year term with a project estimate of $170,030.00. The certificate requires bidders to demonstrate appropriate insurance coverage and designate Hillsborough County, a political subdivision of the state of Florida, as an Additional Insured on their General, Auto, and Aircraft Liability Policies.
The Certificate of Liability Insurance requires contractors to provide comprehensive coverage documentation including General Liability, Automobile Liability, Workers' Compensation and Employer's Liability, and other applicable insurance types with specified limits. The form mandates that insurance policies remain in force and cannot be cancelled or modified without providing 30 days' written notice to the certificate holder at the Hillsborough County - BOCC Risk Management Division, located at 601 E. Kennedy Boulevard, 26th Floor, Tampa, Florida 33602. Contractors must ensure that contractual liability coverage is included in listed policies and that a Separation of Insureds provision is present in General Liability Policies. This documentation is a standard requirement for participation in the competitive bidding process and demonstrates the contractor's financial responsibility and commitment to maintaining adequate coverage throughout the 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 .