2-Insurance Certificate.doc
DOC document 94 KB Posted
- Attached to
- Motor Rewind Services
- Solicitation number
- ITB-26-00174
- Issued by
- Hillsborough County, Florida
About this file
This is a Certificate of Liability Insurance template issued on behalf of Hillsborough County, a political subdivision of the State of Florida, relating to a Motor Rewind Services contract opportunity. The certificate documents insurance policies that have been issued to a contractor and are currently in force. The policies include provisions prohibiting cancellation or reduction of coverage without 30 days' written notice to the certificate holder. Hillsborough County's Board of County Commissioners is seeking competitive sealed bids from qualified contractors with proven experience in motor rewind and repair services. The resulting contract will have a five-year term with an estimated project value of $3,310,390.00.
The certificate template requires contractors to maintain multiple types of insurance coverage, including General Liability, Automobile Liability, Garage Liability, Excess Liability, and Workers' Compensation and Employer's Liability insurance. Contractors must name Hillsborough County as an Additional Insured on the General, Auto, and Aircraft Liability policies, and the General Liability policies must include a Separation of Insureds provision. The certificate holder is Hillsborough County's Risk Management Division, located at 601 E. Kennedy Boulevard, 26th Floor, Tampa, Florida 33602, with fax number 813-635-8284. All insurance policy limits, effective dates, expiration dates, and specific coverage amounts must be completed by the insurance producer prior to submission.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 4-Direct Deposit Authorization Form 5.15.2025.pdf.pdf | ||
| 6-ITB-26-00174 Insurance Requirements.pdf | ||
| 5-ITB-26-00174 Motor Rewind Services.pdf | ||
| 3-Substitute W9 Form.pdf.pdf | ||
| 1-Drug Free Workplace Form.doc | DOC document |
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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 .