1-Certificate of Insurance.pdf

This is a Certificate of Insurance example template for the Glendal Elementary School District that contractors must complete prior to commencing services under their contract. The template outlines required insurance coverages including comprehensive general liability with minimum limits of $1,000,000 per person and $2,000,000 per occurrence for bodily injury, $1,000,000 for property damage, comprehensive auto liability, umbrella liability, and workers' compensation and employer's liability with statutory coverage for each accident at $100,000. The certificate must list the insurance agency information, insured contractor details, policy numbers, expiration dates, and specify that coverages include premises operations, contractual, independent contractors, products/completed operations hazard, personal injury, broad form property damage, and explosion & collapse coverage where applicable.

The certificate requires the Glendal Elementary School District to be named as additional insured and specifies that policies cannot expire, be cancelled, or materially changed without thirty days written notice to the district. The template includes sections for the certificate holder's name and address, date issued, and requires an authorized representative signature from the insurance company. This standard insurance certification form ensures contractors maintain adequate coverage levels throughout the contract term to protect both the contractor and the school district from potential liabilities arising from the contracted services.