Insurance_Certification.pdf
PDF 59 KB Posted
- Attached to
- Rob Sullivan Park Maintenance Barn State and local contract opportunity
- Solicitation number
- 05-15
- Issued by
- Volusia County, Florida
About this file
This is an Insurance Certification document for the City of DeBary's Rob Sullivan Park Maintenance Barn project (Bid #05-15), located at 16 Colomba Road, DeBary, Florida 32713. The project involves the delivery and installation of a 25' x 40' x 14' A-frame steel building, with permits to be handled by the City. The certification form requires contractors to provide Certificates of Insurance that comply with the limits and requirements specified in the General Conditions and Supplementary Conditions of the contract. The document serves as official acknowledgment that numbered insurance policies have been issued by identified insurance companies in conformance with project requirements.
The Insurance Certification form requires the Named Insured to list the insurance company, address, state, and zip code, along with an authorized representative's signature and printed name. The insurance company must waive its rights of subrogation against the additional insured as part of the coverage requirements. Contractors are required to attach Acknowledgments with their certification submissions, and additional copies of the form should be provided if multiple insurance companies are providing contract-required insurance coverage.
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Text version
City of Debary – Rob Sullivan Park Maintenance Barn (Bid # 05-15)
SECTION 00620
INSURANCE CERTIFICATION
Name of Project: City of DeBary Rob Sullivan Park Maintenance Barn Owner: City of DeBary 16 Colomba Road DeBary, Florida 32713 Ph. 386-668-2040
Engineer: City of DeBary 16 Colomba Rd.
DeBary, Florida 327136 Ph. 386-668-2040
THIS IS TO CERTIFY that the numbered policies identified by the attached Certificates of Insurance have been issued by the below stated company in conformance with the limits and requirements as set forth in the General Conditions and Supplementary Conditions.
The insurance company hereby waives its rights of subrogation against the additional insured.
Named Insured
Insurance Company
Address City State Zip
By:
Signature of Authorized Representative
Printed or Typed Name of Authorized Representative (Attach Acknowledgment)
(Make additional copies of this form if more than one insurance company provides contract required insurance).
END OF SECTION
File details come from the government source that posted it. Updated .