2-Insurance Certificate.doc
DOC document 94 KB Posted
- Attached to
- Predictive Electrical and Mechanical Maintenance State and local contract opportunity
- Solicitation number
- ITB-26-00163
- Issued by
- Hillsborough County, Florida
About this file
This is a Certificate of Liability Insurance document related to Hillsborough County Board of County Commissioners' Predictive Electrical and Mechanical Maintenance contract opportunity in Florida. The certificate serves as proof that insurance policies have been issued to a contractor and are currently in force. The document certifies that all listed policies include 30-day cancellation notice provisions to the certificate holder. Hillsborough County, identified as a political subdivision of the State of Florida, has been named as an Additional Insured on the General, Auto, and Aircraft Liability Policies. The certificate holder address is listed as Hillsborough County - BOCC Risk Management Division, 601 E. Kennedy Blvd, 26th Floor, Tampa, FL 33602, with fax number 813-635-8284.
The insurance certificate requires contractors to maintain multiple types of coverage including General Liability (with Commercial General Liability, General Aggregate, Fire Damage, Personal & Advertising Injury, and Products-Completed Operations Aggregate limits), Automobile Liability (with options for any auto, owned autos, scheduled autos, hired autos, or non-owned autos coverage), Garage Liability, Excess Liability, and Workers' Compensation and Employer's Liability insurance. Specific dollar limits for each coverage type are to be completed by the contractor's insurance provider. The document indicates that Contractual Liability Coverage must be included in the listed General and Auto Liability Policies, and the General Liability Policies must include a Separation of Insureds provision. The certificate was issued on form ICM-015 (09/10).
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| 1-Drug Free Workplace Form.doc | DOC document | |
| 3-Substitute W9 Form.pdf.pdf | ||
| 5-ITB-26-00163 Predictive Electrical and Mechanical Maintenance.pdf | ||
| 4-Direct Deposit Authorization Form 5.15.2025.pdf.pdf | ||
| 6-ITB-26-00163 Insurance Requirements.pdf |
On GovTribe
Work with this file on GovTribe
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .