Sample_Insurance_Certificate.pdf

PDF 70 KB Posted

Attached to
Lift Station # 64 Rehabilitation
Solicitation number
PSUT-25-09
Issued by
Broward County, Florida

About this file

This document is an ACORD Certificate of Liability Insurance template for the City of Pembroke Pines, Florida, located at 601 City Center Way. The sample certificate provides guidance for companies submitting insurance documentation, with specific requirements for general liability coverage. The template instructs bidders/vendors to include general liability insurance and explicitly name the City of Pembroke Pines as the certificate holder and additionally insured party.

The certificate requires comprehensive insurance coverage details, including policy numbers, effective dates, expiration dates, and specific coverage limits across various insurance categories such as general liability, automobile liability, and workers' compensation. Key stipulations include mandatory inclusion of general liability coverage and a specific wording requirement that states "THE CERTIFICATE HOLDER IS NAMED AS ADDITIONALLY INSURED WITH REGARD TO GENERAL LIABILITY" which must be present on the submitted certificate. The document serves as a standardized template to ensure consistent insurance documentation for municipal contracts and provides clear instructions for potential vendors seeking to do business with the City of Pembroke Pines.

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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 .