Sample_Insurance_Certificate.pdf

PDF 70 KB Posted

Attached to
Academic Village Cooling Tower
Solicitation number
PSPW-25-10
Issued by
Broward County, Florida

About this file

This document is an ACORD Certificate of Liability Insurance Sample template for a contract with the City of Pembroke Pines, Florida, specifically related to the Academic Village Cooling Tower project. The certificate serves as a standard insurance documentation form that requires the bidding company to provide general liability insurance coverage, with the City of Pembroke Pines named as the certificate holder and additionally insured. The template mandates specific insurance requirements, including the need to list the city's full address (601 City Center Way, Pembroke Pines, FL 33025) and include a statement that "THE CERTIFICATE HOLDER IS NAMED AS ADDITIONALLY INSURED WITH REGARD TO GENERAL LIABILITY".

The insurance certificate is part of the procurement documentation for a critical HVAC infrastructure replacement project at the Pembroke Pines Charter School Academic Village Campus. The project involves demolishing existing cooling towers that have reached the end of their useful life and installing new stainless-steel units to ensure continuous cooling, improve system efficiency, and provide reliable service. While the certificate itself does not specify exact pricing or funding sources, it represents a standard risk management requirement for contractors bidding on municipal infrastructure projects, ensuring that the city is protected through appropriate liability insurance coverage during the project's execution.

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YOUR COMPANY NAME HERE Companies providing coverage

SAMPLE CERTIFICATE

Must Include General Liability

City of Pembroke Pines 601 City Center Way Pembroke Pines FL 33025

City Must Be Named as Certificate Holder

"THE CERTIFICATE HOLDER IS NAMED AS ADDITIONALLY INSURED WITH REGARD TO GENERAL LIABILITY"

Certificate must contain wording similar to what appears below

File details come from the government source that posted it. Updated .