2-Insurance Certificate.doc.doc
DOC document 94 KB Posted
- Attached to
- Real Estate Title Services
- Solicitation number
- RFP-26-00328
- Issued by
- Hillsborough County, Florida
About this file
This is a Certificate of Liability Insurance document for Hillsborough County Board of County Commissioners (BOCC) Risk Management Division in Florida, related to a Real Estate Title Services contract opportunity. The certificate serves as formal documentation that insurance policies meeting specified coverage requirements have been issued to a contractor and remain in force. The document establishes that coverage will not be cancelled or modified to reduce described limits without providing 30 days' written notice to the certificate holder at the Hillsborough County BOCC Risk Management Division, located at 601 E. Kennedy Boulevard, 17th Floor, Tampa, Florida 33602. Hillsborough County, as a political subdivision of the State of Florida, must be named as an additional insured on all general, automobile, and aircraft liability policies. The contract opportunity itself involves providing ongoing and as-needed real estate title services for various properties within Hillsborough County over a five-year period with an estimated project value of $250,000.00.
The certificate template indicates required insurance coverage categories including general liability (with specified aggregate and per-occurrence limits), automobile liability, garage liability, excess liability, and workers' compensation with employer's liability. The document requires contractors to complete all applicable sections detailing policy numbers, effective and expiration dates, and specific coverage limits for each insurance type. All listed general liability policies must include a separation of insureds provision, and contractual liability coverage must be incorporated into the general and automobile liability policies. The certificate holder information designates contact details as Fax No. 813-635-8284 for the Hillsborough County BOCC Risk Management Division, ensuring proper notification procedures for any policy changes or cancellations throughout the contract term.
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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 .