3-Certificate of Insurance.pdf

This is a Certificate of Insurance template form for the Glendale Elementary School District that contractors must complete prior to commencing services under a district contract. The form requires contractors to provide certification from their insurer for various types of coverage including comprehensive general liability, premises operations, contractual coverage, independent contractors coverage, products/completed operations hazard, personal injury, broad form property damage, explosion and collapse coverage, underground hazard coverage, comprehensive auto liability, umbrella liability, and workmen's compensation and employer's liability insurance.

The form specifies minimum coverage amounts with bodily injury coverage requiring $1,000,000 per person and $2,000,000 per occurrence, property damage coverage of $1,000,000, and statutory workmen's compensation coverage of $100,000 per accident. The certificate must identify the insurance agency, insured parties, policy numbers, and expiration dates for all coverages. The district must be named as an additional insured, and the form includes provisions that no policy shall expire, be cancelled, or materially changed without thirty days written notice to the district. All coverages must be maintained in full force and effect during the entire contract term and cannot serve to limit other contractor obligations.