6-2026-09 Contractors - COI Template.pdf
PDF 337 KB Posted
- Attached to
- HVAC Controls On-Call Service and Repairs
- Solicitation number
- 2026-09
- Issued by
- Fairfield County, Connecticut
About this file
This document is an ACORD Certificate of Liability Insurance for the Town of Fairfield, Connecticut, specifically for the Fairfield Board of Education. The certificate is a sample form detailing insurance coverage requirements for contractors, with comprehensive insurance policies including Commercial General Liability, Automobile Liability, Umbrella Liability, Workers Compensation, Pollution Liability, and Crime coverage. The document specifies various insurance limits, such as $1,000,000 per occurrence for Commercial General Liability and $2,000,000 aggregate, with additional coverage for property damage, bodily injury, and other potential risks.
The insurance certificate stipulates that the Town of Fairfield, Fairfield Board of Education, its officers, officials, employees, and agents are included as additional insured on all insurance policies (except Workers Compensation) on a primary and non-contributory basis. The policies include a waiver of subrogation in favor of the certificate holder, and the insurance provider must give thirty (30) days prior written notice of cancellation to the Town (ten days for non-payment of premium). The document is a standard ACORD form designed to provide proof of insurance coverage and protect the municipal entity from potential liability in contractor operations.
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Text version
Town of Fairfield Sullivan Independence Hall 725 Old Post Road Fairfield, CT 06824
X X
X X
Project Name:
The Town of Fairfield, Fairfield Board of Educations, its officers, officials, employees, and agents, Boards and Commissions are included as additional insured for all insurance policies except Workers Compensation, on a primary and non-contributory basis. All policies include a waiver of subrogation in favor of the certificate holder. Thirty (30) days prior written notice of cancellation will be given to the Town (Ten (10) days for non-payment of premium).
Insurance Agent Name and Address
Vendor/Contractor Name/Address/Contact
Vendor/Contractor Insurance Companies Enter NAIC #
Month/Date/Year
Policy Number
Policy Number
Policy Number
Policy Number
Effective
Date
Date
Date
Date
Date
Date
Date
Date
Signature
Effective
Effective Effective
Effective Effective
Effective Effective
Contractors SAMPLE x x x x X X x x x
Insurance Agent Contact
1,000,000
2,000,000
1,000,000
3,000,000
500,000
500,000 500,000
100,000 5,000 1,000,000
2,000,000
Pollution Liability $1,000,000Policy Number (s) Effective Effective Date (s) Date (s)
CA 9948 Endorsement
Crime $1,000,000
File details come from the government source that posted it. Updated .