2-Certificate of Liability Insurance Sample - Acord 25.pdf
PDF 645 KB Posted
- Solicitation number
- RFP #26-007
- Issued by
- Upton County, Texas
About this file
This is a Certificate of Liability Insurance sample document (ACORD 25 form) provided by the Laredo Independent School District in Texas for vendors and contractors bidding on the removal of grease trap(s), interceptor(s), and barrel(s) services for the district's Child Nutrition Program. All vendors and contractors are required to submit a Certificate of Insurance to Laredo ISD that complies with the specifications outlined in this sample document. The certificate must include coverage for General Liability, Auto Liability, Workers' Compensation, and Umbrella Excess (Liability) policies, with the certificate holder listed as an Additional Insured and granted a Waiver of Subrogation on all policies.
The required insurance coverage limits are $1,000,000 for General Liability, $1,000,000 for Auto Liability, Statutory Limits for Workers' Compensation, and $5,000,000 for Umbrella Excess Liability, though higher limits may be required. Coverage must be primary and non-contributory with respect to General Liability, Automobile, and Umbrella Liability. All policies must provide a minimum of 30 days' notice of cancellation to Laredo ISD (except 10 days for non-payment). The insurance agent or broker must provide the certificate with complete policy information, policy numbers, and effective dates. The certificate should be mailed to Laredo Independent School District, 900 East Lyons, Laredo, TX 78040.
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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 .