Sample_Insurance_Certificate.pdf

PDF 70 KB Posted

Attached to
CCNA Sunswept Community Water System Replacement Program State and local contract opportunity
Solicitation number
PSUT-25-14
Issued by
Broward County, Florida

About this file

This is a sample insurance certificate document related to the City of Pembroke Pines' CCNA Sunswept Community Water System Replacement Program in Florida. The certificate appears to be a standard template for documenting insurance coverage requirements, though the specific details are partially illegible in the provided image. The document contains typical certificate of insurance fields and sections for documenting coverage information, policy numbers, effective dates, and insured party details that would be required from contractors or consultants working on municipal projects.

The insurance certificate would serve as evidence of required liability and other protective coverage for the engineering design and related services being solicited by the City of Pembroke Pines. Given the scope of the project—which involves water main replacement, service replacements, meter relocations, and fire hydrant work across residential and commercial areas—contractors responding to this CCNA solicitation would be expected to provide proof of adequate insurance coverage through such certificates. The specific coverage amounts, policy types, and insurance requirements would typically be detailed in the main solicitation documents and contract specifications, with this certificate serving as the contractor's documentation of compliance with those insurance requirements.

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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 .