8-Insurance Certificate.doc.doc
DOC document 94 KB Posted
- Attached to
- Tree Trimming and Removal Services
- Solicitation number
- RFP-2026-01-0-2027/AB
- Issued by
- Brevard County, Florida
About this file
This is a Certificate of Liability Insurance template issued by Hillsborough County's Risk Management Division in Tampa, Florida, applicable to contractors performing services for state and local government entities in Florida. The certificate serves as proof that an insured contractor maintains active insurance policies meeting specified coverage requirements. The document establishes that insurance policies will remain in force and cannot be cancelled or materially reduced without providing 30 days' written notice to the certificate holder, Hillsborough County – BOCC Risk Management Division, located at 601 E. Kennedy Boulevard, 17th Floor, Tampa, FL 33602.
The certificate template addresses multiple types of required insurance coverage, including Commercial General Liability (with options for claims-made or occurrence basis), Automobile Liability, Garage Liability, Excess Liability, and Workers' Compensation and Employer's Liability. The form includes designated fields for policy numbers, effective and expiration dates, and specific coverage limits across various categories such as general aggregate limits, each occurrence limits, fire damage, personal and advertising injury, products-completed operations aggregate, bodily injury, and property damage. The document requires that Hillsborough County, as a political subdivision of the State of Florida, be named as an additional insured on the General, Auto, and Aircraft Liability policies. The certificate must be signed by an authorized representative of the insured contractor and submitted to the county's Risk Management Division prior to commencing work on any contract opportunity, such as the Tree Trimming and Removal Services contract with the City of Rockledge.
View the file
Other files
Show all 25
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 .