2-Insurance Certificate.doc
DOC document 94 KB Posted
- Attached to
- Low Voltage Cabling
- Solicitation number
- ITB-26-00215
- Issued by
- Hillsborough County, Florida
About this file
This is a Certificate of Liability Insurance template issued by Hillsborough County Board of County Commissioners (BOCC) Risk Management Division for a Low Voltage Cabling contract opportunity valued at $8,741,746.98 over a five-year period. The certificate outlines the required insurance coverages that contractors must maintain throughout the contract term. The document specifies that Hillsborough County, as a political subdivision of the State of Florida, must be named as an Additional Insured on all General, Auto, and Aircraft Liability policies. Contractors are required to provide proof of insurance with 30-day cancellation notice provisions to ensure continuous coverage protection.
The insurance requirements include General Liability, Automobile Liability, Workers' Compensation and Employer's Liability coverage, with additional options for Garage Liability and Excess Liability as applicable. The certificate mandates that all policies include contractual liability coverage and a Separation of Insureds (severability of interests) provision. Specific policy limits and coverage amounts must be completed on the certificate form and submitted to the Certificate Holder at Hillsborough County - BOCC Risk Management Division, 601 E. Kennedy Blvd, 26th FL, Tampa, FL 33602, with fax notification capability at 813-635-8284. This insurance documentation requirement is a standard prerequisite for bidders seeking to contract with Hillsborough County for the low voltage cabling services project.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 6-ITB-26-00215 Low Voltage Cabling Services.pdf | ||
| 4-Direct Deposit Authorization Form 5.15.2025.pdf.pdf | ||
| 5-ITB-26-00215 Insurance Requirements.pdf | ||
| 3-Substitute W9 Form.pdf.pdf | ||
| 1-Drug Free Workplace Form.doc | DOC document |
On GovTribe
Work with this file
- 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 .