2-Insurance Certificate.doc
DOC document 94 KB Posted
- Attached to
- Emergency Shelter Staffing
- Solicitation number
- ITB-26-00131
- 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, as the certificate holder. The document serves as proof that insurance policies have been issued to an unspecified insured and are currently in force. The certificate confirms that all listed policies include 30-day written notice requirements before cancellation or modification of coverage. The form is structured to document multiple types of insurance coverage, including General Liability, Automobile Liability, Garage Liability, Excess Liability, and Workers' Compensation and Employer's Liability, with designated spaces for policy numbers, effective dates, expiration dates, and coverage limits. Hillsborough County, specifically its 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 indicates 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 document relates to the Emergency Shelter Staffing contract opportunity with Hillsborough County Fire Rescue and the Office of Emergency Management, which seeks an experienced contractor to provide shelter staffing support services during emergency activations and declared disasters. The three-year contract, estimated at $374,610.00, requires the contractor's trained and certified personnel to be available for rapid deployment and operations in both congregate and non-congregated shelter settings for residents and pets throughout Hillsborough County.
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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 .