7-Certificate of Liability Insurance Sample - Acord 25 (1).pdf
PDF 645 KB Posted
- Solicitation number
- RFP #26-011 Elevator Maintenance, Inspection and Related Services
- 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 elevator maintenance, inspection, and related services. The document outlines insurance requirements that all vendors and contractors must provide to the district before commencing work. The certificate must include coverage for general liability, auto liability, umbrella excess liability, and workers' compensation insurance, with the district listed as an additional insured and certificate holder.
The document specifies minimum coverage limits of $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. All policies must be occurrence-based and provide primary and non-contributory coverage to the district. Insurance carriers must provide 30 days' notice of cancellation to the district (except 10 days for non-payment), and a waiver of subrogation must be granted on all policies including workers' compensation. The certificate holder designation must match the vendor or contractor name as shown in the contract, and the notice of cancellation should be mailed to the Laredo ISD office located at 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 .