8-Insurance Certificate.doc.doc
DOC document 94 KB Posted
- Solicitation number
- IFB-26-00250
- Issued by
- Hillsborough County, Florida
About this file
This is a Certificate of Liability Insurance template document related to Hillsborough County, Florida's Countywide Stormwater Ditch and Side-Drain Restoration Contract. The certificate establishes insurance requirements for contractors performing stormwater restoration work across Hillsborough County on an as-needed, work-order basis. The contract encompasses ditch reshaping, side-drain and cross-drain installation and replacement, pipe culvert work, inlet and outfall installation, selective vegetation removal, stormwater construction under wet conditions, and localized roadway shoulder and right-of-way restoration activities. The initial contract term is one year with two optional one-year renewal periods exercisable at the County's discretion. Bids were due July 31, 2026, with the estimated contract value of $4.938 million.
The insurance certificate requires contractors to maintain comprehensive general liability coverage with Hillsborough County named as an additional insured, along with workers' compensation and employer's liability coverage. Contractors must also obtain automobile liability, excess liability, and contractual liability coverage as specified in the certificate. The certificate holder is the Hillsborough County Risk Management Division (601 E. Kennedy Blvd, 17th Floor, Tampa, FL 33602), with a fax number of 813-635-8284. Insurance policies must include a 30-day cancellation notice provision to the certificate holder and a severability of interests clause in the general liability policies. An 8% Small Business Enterprise subcontractor participation goal applies to the contract, and contractors must hold a valid Florida Certified General Contractor or Registered General Contractor license at bid opening. Bid bonds equal to 5% of the bid amount and performance and payment bonds each equal to 100% of the awarded contract amount are required.
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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 .