HomeMy WebLinkAboutattachmentNPREVIOUS CONTRACT NO. H-5-01-090-81
BID NO. H- -
CERTIFICATE OF INSURANCE FOR REPAIR MAINTENANCE & INSTALLATION OF ROADWAYS SYSTEMS
be required of the selected firm and identified in the negotiated agreement. Any deviation or change during the
contract ne,otiation -eriod shall be a- -roved b Risk Mena-ement.
GENERAL LIABILITY
(� Commercial Form
(►i• Prem i s es -Operations
( Explosion & Collapse Hazard
Underground Hazard
Products/Completed
3(Operations Hazard
Contractual Insurance
Broad Form Property Damage
Independent Contractors
t 1 Personal Injury
(1 Garage
AUTO LIABILITY
(Comprehensive Form
(6r' Owned
( -1- Hired
(r.}'Non-owned
EXCESS LIABILITY
( 1 Umbrella Form
( 1 Other than Umbrella Form
WORKER'S COMPENSATION
AND EMPLOYER'S
LIABILITY (NOTE -)
I -(OTHER
[ j Publisher Professional
iLiability - E & 0
( Property Coverage/
Builder's Risk
ate'-"" OfO0-""Onu`°""O"""'"""' Certificate must show on general liability only:
Additional insured: Broward County Board of County Commissioners, Broward County, Florida
Certificate Must be Signed and Alf applicable Deductibles shown
Note " - If the Company is exempt from Workers' Compensation Coverage, please provide s
letter on Company letterhead or State's exemption which documents this status and attache
to the Certificate of Insurance for appro►el-
Cancellation: Thirty (30) Day written notice of cancellation required to the Certificate Holder:
Nam a Address of certmeate Holder
Brewers! County Board of County Commissioners.•
Purchasing Division, Suite 212
115 South Andrews Avenue ,
Part Lauderdale, FL 33301 ...:; .'.'.`''
RE: Bid E %¢919 6.0‘.Qekt Proj*eblk
Bodily Injury (each accident}
Property Damage
Bodily Injury and Property
Damage Combined
Each Claim
uytvy / c dc-vs /Lr;4,4
•
RMIRS-P1309.2003
12/W03
Page 95 of 95