2-Insurance Certificate.doc
DOC document 94 KB Posted
- Attached to
- Automatic Gate Purchasing, Preventative Maintenance and Repair Services State and local contract opportunity
- Solicitation number
- ITB-26-00157
- Issued by
- Hillsborough County, Florida
About this file
This is a Certificate of Liability Insurance template issued for Hillsborough County, a political subdivision of the state of Florida, specifically related to the Automatic Gate Purchasing, Preventative Maintenance and Repair Services contract. The certificate documents insurance policies required to be in force for contractors performing work on security gate systems, service, repair, and retrofit projects at County parks, boat ramps, and nature preserves. The contract has a two-year term with an estimated project value of $139,158.00. Contractors must maintain active insurance coverage and provide proof through this certificate to Hillsborough County Board of County Commissioners' Risk Management Division.
The Certificate of Liability Insurance requires contractors to carry multiple types of coverage including General Liability, Automobile Liability, Workers' Compensation and Employer's Liability, and other optional coverages such as Garage Liability and Excess Liability. Hillsborough County must be named as an Additional Insured on all General, Auto, and Aircraft Liability policies, and insurers must provide 30 days' written notice before canceling or reducing coverage. The certificate holder is identified as Hillsborough County Risk Management Division located at 601 E. Kennedy Blvd, 26th FL, Tampa, FL 33602, with fax contact at 813-635-8284. This insurance requirement is a standard contractual obligation for all bidders responding to the competitive sealed bid solicitation.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| 4-Direct Deposit Authorization Form 5.15.2025.pdf.pdf | ||
| 6-ITB-26-00157 Attachment A - Automatic Gate Locations.pdf | ||
| 7-ITB-26-00157 Automatic Gates Purchasing Maint and Repair Services.pdf | ||
| 5-ITB-26-00157 Insurance Requirements.pdf | ||
| 1-Drug Free Workplace Form.doc | DOC document | |
| 3-Substitute W9 Form.pdf.pdf |
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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 .