1-Certificate of Liability Insurance Sample - Acord 25.pdf
PDF 645 KB Posted
- Attached to
- RFP # 25-017 General Merchandise and Groceries
- Solicitation number
- Not on record
- Issued by
- Upton County, Texas
About this file
This document is a sample Certificate of Liability Insurance template for Laredo Independent School District (Laredo ISD), designed to be completed by vendors, contractors, and lessees. The certificate outlines required insurance coverage including General Liability, Auto Liability, Umbrella Excess, and Workers' Compensation, with specific recommended policy limits and coverage periods from 1/1/2018 to 1/1/2019.
The certificate specifies that the vendor/contractor must list Laredo ISD as an Additional Insured on General Liability, Automobile, and Umbrella Liability policies, and provide a Waiver of Subrogation on all policies. The document requires 30-day notice of cancellation (except 10 days for non-payment) and emphasizes that coverage must be primary and non-contributory. Customary insurance limits are noted, with recommendations that higher limits may be required, and the certificate must be issued by a licensed insurance agent or broker with all four coverage boxes checked or verified.
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Text version
The following outlines a sample Certificate of Insurance which should be provided to Laredo ISD from ALL Vendors / Contractors..
Insurance Agent / Broker Providing Certificate And Address
A x xx x x x
A
B
A
Insurance Agent/Broker Providing Certificate
Vendor / Contractor / Lessee/ Name Needs to Agree With Contract
Date Issued
Insurance Company
Writing Policy
General Liability
Auto Liability
Umbrella Excess (Limits can be combined with
AL, GL and/or EL to meet req.)
Workers’ Compensation
Commercial General Liability & Occurrence Based
Location name & mailing address: This is where notice of cancellation will be mailed to.
NOTICE OF CANCELLATION
Require 30 days but some agents will not issue more than 10 days because policies can be cancelled in 10 days for non-payment.
Certificate Holder is included as Additional Insured as respects General Liability, Automobile & Umbrella Liability policies and granted a Waiver of Subrogation on all policies including Workers Compensation. Coverage is primary and non-contributory as respects to General Liability, Automobile & Umbrella Liability. In the event of cancellation by the insurance companies all policies have been endorsed to provide (30) days Notice of Cancellation (except (10) days for non-payment) to the certificate holder shown below.
Customary Limits for Umbrella attachment xWC Statutory Limits 1,000,000 1,000,000 1,000,000
5,000,000 5,000,000
Note: Higher limits may be required
8783009889 1/1/2018 1/1/2019
1/1/2018 1/1/2019
ABCE897658 1/1/2018 1/1/2019
XYZ2243433334 1/1/2018 1/1/2019
1,000,000
100,000 50,000
1,000,000 2,000,000 2,000,000
1,000,000
ALL 3 Boxes Checked Also OK
Company A Company B x
Limits Required in ALL Four
Laredo Independent School District 900 East Lyons Laredo, TX 78040
Vendor / Contractor / Lessee Address Name Needs to Agree with Contract
Recommended wording
Slide Number 1
File details come from the government source that posted it. Updated .