Dacs 13616 Form PDF Details

Navigating the complexities of operating a pest control business in Florida requires adherence to certain regulatory standards, particularly with respect to insurance. The DACS 13616 form emerges as a crucial document in this context, issued by the Florida Department of Agriculture and Consumer Services' Division of Agricultural Environmental Services. This Certificate of General Liability Insurance is mandated for every pest control business that applies for a license or its renewal under Section 482.071(4), F.S. and 5E-14.142, F.A.C. The form requires detailed information about the insured business, including its name, physical address, and specifics about the insurance policy such as the policy number and effective dates. Furthermore, it outlines the minimum financial responsibility requirements that the pest control business must meet, covering both bodily injury and property damage liabilities. It also delves into additional insurance coverage for performing wood-destroying organism inspections, stressing the importance of errors and omissions (professional liability) coverage. The DACS 13616 form, therefore, plays a pivotal role in ensuring that pest control businesses in Florida maintain the necessary financial safeguards, aligned with statutory requirements, to protect both themselves and their clients.

QuestionAnswer
Form NameDacs 13616 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesdacs13616, Florida, PUTNAM, flaes

Form Preview Example

NICOLE "NIKKI" FRIED

COMMISSIONER

Florida Department of Agriculture and Consumer Services

Division of Agricultural Environmental Services

CERTIFICATE OF GENERAL LIABILITY INSURANCE PERTAINING TO PEST CONTROL BUSINESS LICENSE

Section 482.071(4), F.S. and 5E-14.142, F.A.C.

Telephone: 850-617-7997

Respond to:

Bureau of Licensing and

Enforcement

3125 Conner Blvd, Bldg 8,

Tallahassee, FL 32399-1650

Insured:

(Pest Control Business)

____________________________________

Business Name

____________________________________________

Physical Address of Business

____________________________________________

City, State, Zip Code

_____________________________________________

Policy Number

_____________________________________________

Policy Effective Date

_____________________________________________

Policy Expiration Date

PRODUCER:

(Insurance Agent)

_______________________________________

Company Name

_______________________________________________

Street or Mailing Address

_______________________________________________

City, State, Zip Code

_______________________________________________

Phone number

Insurance Company(ies) Affording Coverage:

_______________________________________

Company (Letter A - below)

_______________________________________________

Company (Letter B - below)

A.Chapter 482.071(4), Florida Statutes, states, in part, that each person making application for a pest control business license or renewal thereof must furnish to the department a certificate of insurance that meets the requirements for minimum financial responsibility for bodily injury and property damage consisting of:

Bodily injury: $250, 000 each person and $500, 000 each occurrence; and

Property damage: $250,000 each occurrence and $500,000 in the aggregate; or

Combined single-limit coverage: $500,000 in the aggregate.

The insured firm’s coverage meets or exceeds the minimum statutory requirements as stated in “A” above:

____________________________________________________

Authorized Insurance Representative Signature

B.Does the insured have insurance for performing wood-destroying organism inspections in the form of errors and omissions (professional liability) coverage in an amount no less than $500,000 in the aggregate and $250,000 per occurrence?

__________

__________

____________________________________________________

Yes

No

Authorized Insurance Representative Signature

CERTIFICATE HOLDER

Florida Department of Agriculture and Consumer Services

Bureau of Licensing and Enforcement

3125 Conner Blvd, Bldg 8

Tallahassee, FL 32399-1650

(850) 617-7997 FAX: (850) 617-7967

FDACS-13616 Rev. 07/14

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5E-14 completion process clarified (part 1)

2. Once your current task is complete, take the next step – fill out all of these fields - B Does the insured have insurance, Yes No, Authorized Insurance, CERTIFICATE HOLDER Florida, and FDACS Rev with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Stage no. 2 of completing 5E-14

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