6-Certificate of Liability Insurance Sample - Acord 25 (1).pdf
PDF 645 KB Posted
- Solicitation number
- RFP - 26-002
- 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 use by all vendors and contractors engaged in the supply of police and security officer uniforms, tactical gear, and specialized equipment. The document outlines mandatory insurance requirements that must be submitted by all vendors to the district prior to contract execution. The certificate must identify the insurance agent or broker, the vendor or contractor name, the insurance company writing the policy, and the certificate holder address where cancellation notices will be sent to Laredo ISD at 900 East Lyons, Laredo, TX 78040.
The certificate requires vendors to maintain General Liability coverage with limits of $1,000,000, Auto Liability coverage of $1,000,000, Workers' Compensation at statutory limits, and Umbrella or Excess coverage of $5,000,000. All policies must designate the Laredo Independent School District as an additional insured with respect to General Liability, Automobile, and Umbrella Liability policies and must include a waiver of subrogation on all policies including Workers' Compensation. Coverage must be primary and non-contributory. The certificate must provide for thirty days' notice of cancellation to the certificate holder, except in cases of non-payment where ten days' notice is permitted. Higher limits may be required at the district's discretion.
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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 .