COI_Sample.pdf

PDF 1 MB Posted Feb 24, 2026

Attached to: Surveillance Cameras for Satellite Tax Collector's Office
Solicitation number: 15210-26-01
Issued by: San Mateo County, San Bernardino City, California

About this file

Written by GovTribe AI · Apr 6, 2026

This is a Certificate of Liability Insurance issued for the County of San Mateo Treasurer-Tax Collector's Office as the certificate holder. The document serves as proof of insurance coverage for a vendor performing services related to the surveillance camera system installation project at the North County Wellness Center satellite office in South San Francisco, California. The certificate indicates that the insured vendor maintains commercial general liability coverage with limits of $1,000,000 per occurrence, workers' compensation and employers' liability coverage of $1,000,000 each, and automobile liability coverage with combined single limits of $1,000,000. The County of San Mateo is designated as an additional insured on the commercial general liability policy through endorsement CG 20 26 0413, which extends coverage to the County for bodily injury, property damage, or personal and advertising injury caused by the vendor's acts or omissions in the performance of ongoing operations or in connection with premises owned by or rented to the vendor. The certificate provides policy numbers, effective dates, and expiration dates for each coverage type, with all policies current at the time of issuance.

The insurance requirements represent mandatory compliance obligations for any vendor bidding on the surveillance camera system project. These coverage minimums and additional insured status are contractual prerequisites that vendors must satisfy prior to award and throughout the contract term of one year. The document format is a standard ACORD 25 form (2014/01 edition), which is the industry-standard certificate of insurance used across commercial and government contracting. All insurance policies listed remain subject to their respective terms, exclusions, and conditions, and the certificate confers no rights upon the certificate holder independent of the actual policy endorsements and provisions.

View the file

Other files

File	Type	Posted
Surveillance_Cameras_for_Satellite_Tax_Collector's_Office_(Addendum_#2_Revision).pdf	PDF	Mar 10, 2026
Surveillance_Cameras_for_Satellite_Tax_Collector's_Office_(Addendum_#1_Revision).pdf	PDF	Feb 24, 2026
COI_Sample.pdf	PDF	Feb 24, 2026
B._Standard_Contract_Template_-_Under_$200K_(Levine_Act_added).pdf	PDF	Feb 20, 2026
C._Pages_from_NCWC_-_DELTA_43A_-_ARCH+ELEC+TECH_2025-1114.pdf	PDF	Feb 20, 2026
Standard_Contract_Template_-_Over_$200K_DRAFT.docx	DOCX document	Feb 11, 2026

On GovTribe

Work with this file

Download the original file
Contacts named in this file
Similar government files
Ask GovTribe AI about this file

Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE

THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED

REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).

PRODUCER CONTACT

NAME:

PHONE

(A/C, No, Ext):

FAX

(A/C, No):

E-MAIL

ADDRESS:

INSURER(S) AFFORDING COVERAGE NAIC #

INSURER A :

INSURED INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

CERTIFICATE HOLDER

AUTHORIZED REPRESENTATIVE

CANCELLATION

LOCJECT

PRO-POLICY

GEN'L AGGREGATE LIMIT APPLIES PER:

OCCURCLAIMS-MADE

COMMERCIAL GENERAL LIABILITY

PREMISES (Ea occurrence) $

DAMAGE TO RENTED

EACH OCCURRENCE $

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GENERAL AGGREGATE $

PRODUCTS - COMP/OP AGG $

$RETENTIONDED

CLAIMS-MADE

OCCUR

AGGREGATE $

EACH OCCURRENCE $UMBRELLA LIAB

EXCESS LIAB

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

INSR

LTR TYPE OF INSURANCE POLICY NUMBER

POLICY EFF

(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY) LIMITS

PER

STATUTE

OTH-

E.L. EACH ACCIDENT

E.L. DISEASE - EA EMPLOYEE

E.L. DISEASE - POLICY LIMIT

ANY PROPRIETOR/PARTNER/EXECUTIVE

If yes, describe under DESCRIPTION OF OPERATIONS below

(Mandatory in NH)

OFFICER/MEMBER EXCLUDED?

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY Y / N

AUTOMOBILE LIABILITY

ANY AUTO

ALL OWNED SCHEDULED

HIRED AUTOS

NON-OWNED

AUTOS AUTOS

AUTOS

COMBINED SINGLE LIMIT

BODILY INJURY (Per person)

BODILY INJURY (Per accident)

PROPERTY DAMAGE $

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

INSD

ADDL

WVD

SUBR

N / A

(Ea accident)

(Per accident)

OTHER:

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD

NName of Insurance CompanyAME OAddressY ADDRESS CCity, State, Zip CodeP CODE

NAME OF VENDOR

Company NameO Address City, State Zip CodeDE

Name of AgentAME OF AGENT

Agency Phone NumberENCY PHONE NUMBER

Agency EmailGENCY EMAIL

Insurance Carrier(s) NamesINSURANCE CARRIER(S) NAMES

Agency Fax NumberFER

PPolicy NumberOLICY NUMBER Effective Date Expiration Date 1,000,000

Dates must be current

Policy Number

If worker's comp. is not included here, a separate certificate is required.

Effective Date Expiration DateN

1,000,000

Effective DateTIVE Expiration Date

AAbove information should be typed here.bove information should be typed here.

County's name must be typed in this box.

County of San Mateo Treasurer-Tax Collector 555 County Center, 1st Floor Redwood City, CA 940633

SIGNATURE

DATE

SAMPLEPolicy Number

1,000,000

500,000

20,000

1,000,000

Jennifer Tran Highlight

POLICY NUMBER: COMMERCIAL GENERAL LIABILITY

CG 20 26 0413

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED - DESIGNATED

PERSON OR ORGANIZATION

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

SCHEDULE

Name Of Additional Insured Person(s) Or Organization(s):

County of San Mateo

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf:

1. In the performance of your ongoing operations;

2. In connection with your premises owned by or rented to you.

However:

1. The insurance afforded to such additional insured only applies to the extent permitted by law; and

2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.

B. With respect to the insurance afforded to these additional insureds, the following is added to Section Ill - Limits Of Insurance:

If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:

1. Required by the contract or agreement; or

2. Available under the applicable Limits of Insurance shown in the Declarations;

whichever is less.

This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.

The County's name must be typed in this box.

Policy Number

Jennifer Tran Highlight

Untitled

File details come from the government source that posted it. Updated Apr 6, 2026.