2-Insurance Certificate.doc.doc
DOC document 94 KB Posted
- Attached to
- Horse Hay Provider
- Solicitation number
- RFQ-25-00340
- Issued by
- Hillsborough County, Florida
About this file
This is a Certificate of Liability Insurance template document related to Hillsborough County, Florida's procurement for horse hay provider services. The certificate template establishes the insurance requirements that vendors must meet for the two-year contract to supply Orchardgrass/Alfalfa and Alfalfa horse hay bales for 17 horses at the Bakas Equestrian Center, with a total aggregate value of $120,000. The template includes fields for various insurance coverage types including General Liability, Automobile Liability, Garage Liability, Excess Liability, and Workers' Compensation, with specific provisions requiring that Hillsborough County be named as an Additional Insured on the listed policies.
The certificate template specifies that insurance policies must provide 30 days written notice prior to cancellation or changes that would reduce coverage, and includes contractual liability coverage requirements. The document establishes that vendors' pickup locations must be within 50 miles of the Bakas Equestrian Center, and the County currently utilizes three existing vendors: Agi-Feed, Inc. d/b/a Feed Depot, G Five Feed & Outdoor LLC, and Jernan LLC d/b/a AAA Feed Depot. The insurance certificate must be submitted to Hillsborough County's Risk Management Division at 601 E. Kennedy Blvd, 17th Floor, Tampa, FL 33602, with specific formatting requirements including authorized representative signatures.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 3-Substitute W9 Form.pdf.pdf | ||
| 5-RFQ-25-0340 Horse Hay Provider Notice - Attachment A.pdf | ||
| 1-Drug Free Workplace Form.doc.doc | DOC document | |
| 4-RFQ-25-0340 Horse Hay Provider Notice - Attachment A.pdf |
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, 17th FL
Tampa, FL 33602 Authorized Representative:
Signature _____________________________________
ICM – 015 (09/10)
File details come from the government source that posted it. Updated .