2-Insurance Certificate.doc.doc
DOC document 94 KB Posted
- Attached to
- Cat Litter
- Solicitation number
- ITQ-26-00201
- Issued by
- Hillsborough County, Florida
About this file
This is a Certificate of Liability Insurance document for Hillsborough County Board of County Commissioners, located in Tampa, Florida. The certificate outlines the insurance requirements and coverage details that must be maintained by contractors and suppliers engaged with the county. The document serves as proof that required insurance policies are in force and will not be cancelled or materially modified without providing 30 days' written notice to the certificate holder. Hillsborough County, a political subdivision of the state of Florida, must be named as an Additional Insured on all applicable liability policies. The certificate template accommodates multiple types of coverage including General Liability, Automobile Liability, Garage Liability, Excess Liability, and Workers' Compensation and Employer's Liability insurance, with designated spaces for policy numbers, effective dates, expiration dates, and specific coverage limits for each category.
The certificate requires that all listed insurance policies remain active and enforceable throughout the term of any contract with the county. Contractors must verify compliance with the certificate holder's requirements by having an authorized representative sign and date the document before submission. The Risk Management Division of Hillsborough County, located at 601 E. Kennedy Boulevard, 17th Floor, Tampa, Florida 33602, serves as the certificate holder with a fax number of 813-635-8284. This certificate is essential documentation for the cat litter supply contract opportunity, which has an estimated project value of $37,500.00 for a one-year term, as the county requires all qualified suppliers to demonstrate adequate insurance coverage prior to contract award.
View the file
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| 4-Direct Deposit Authorization Form 5.15.2025.pdf.pdf | ||
| 5-ITQ-26-00201 Insurance Requirements.pdf | ||
| 6-ITQ-26-00201 Cat Litter.pdf | ||
| 3-Substitute W9 Form.pdf.pdf | ||
| 1-Drug Free Workplace Form.doc.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, 17th FL
Tampa, FL 33602 Authorized Representative:
Signature _____________________________________
ICM – 015 (09/10)
File details come from the government source that posted it. Updated .