9-Contractors - COI Template.pdf
PDF 337 KB Posted
- Attached to
- Culvert Replacement - Verna Hill Road
- Solicitation number
- 2026-12
- Issued by
- Fairfield County, Connecticut
About this file
This document is an ACORD Certificate of Liability Insurance for the Town of Fairfield, Connecticut, specifically involving the Fairfield Board of Education. The certificate is a sample template that outlines comprehensive insurance coverage details for a contractor, including various insurance policy types such as Commercial General Liability, Auto Liability, Umbrella Liability, and Workers' Compensation. The document specifies coverage limits, with commercial general liability set at $1,000,000 per occurrence and $2,000,000 aggregate, and additional coverages like Pollution Liability at $1,000,000 and Crime insurance at $1,000,000.
The insurance certificate includes critical provisions 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 insurer must provide thirty (30) days prior written notice of cancellation to the Town (ten (10) days for non-payment of premium). The document is a standard ACORD form (version 25, dated 2014/01) used to certify insurance coverage and provide essential details about the contractor's insurance policies.
View the file
Other files
Show all 11
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .