2-Insurance Certificate.doc.doc
DOC document 94 KB Posted
- Attached to
- Integrated Technical Resources Hub
- Solicitation number
- RFP-26-00336
- Issued by
- Hillsborough County, Florida
About this file
This is a Certificate of Liability Insurance form related to a contract opportunity with Hillsborough County Board of County Commissioners in Florida for an Integrated Technical Resources Hub project. The certificate serves as proof that insurance policies have been issued to cover the contractor's work and are currently in force. The document establishes that Hillsborough County, as a political subdivision of the state of Florida, has been named as an additional insured on the listed general, auto, and aircraft liability policies. The certificate requires that any cancellation or reduction in coverage cannot occur without 30 days' written notice to the certificate holder. The document provides spaces for documentation of multiple insurance types including general liability, automobile liability, garage liability, excess liability, and workers' compensation and employer's liability coverage, along with corresponding policy numbers, effective dates, expiration dates, and coverage limits.
The certificate holder is identified as Hillsborough County's BOCC Risk Management Division located at 601 E. Kennedy Boulevard, 17th Floor, Tampa, Florida 33602, with a fax number of 813-635-8284. The insurance requirements are standard contractual provisions for a professional services engagement, in this case related to the three-year Integrated Technical Resources Hub project estimated at $194,150.00 that will provide a cloud-hosted technical resources platform for the Development Services Department.
View the file
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| 8-RFP-26-00336 Vendor Security Outsourcing Questionnaire.xlsx | XLSX spreadsheet | |
| 3-Substitute W9 Form.pdf.pdf | ||
| 4-Direct Deposit Authorization Form 5.15.2025.pdf.pdf | ||
| 5-RFP-26-00336 Insurance Requirements.pdf | ||
| 10-RFP-26-00336 AI Security Questionnaire.xlsx | XLSX spreadsheet | |
| 6-RFP-26-00336 Attachment A - Cybersecurity Requirements.pdf | ||
| 1-Drug Free Workplace Form.doc.doc | DOC document | |
| 9-RFP-26-00336 Integrated Technical Resources Hub.pdf | ||
| 7-RFP-26-00336 Vendor Security Software Questionnaire.xlsx | XLSX spreadsheet |
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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 .