Exhibit F_Sample COI.pdf
PDF 138 KB Posted
- Solicitation number
- 1012A
- Issued by
- Denver County, Denver City, Colorado
About this file
This document is a Contractor Certificate of Liability Insurance template issued by the City and County of Denver, intended to provide guidance for contractors seeking to submit insurance documentation for municipal contracts. The template specifies detailed requirements for insurance certificates, including mandatory policy types, coverage limits, and additional insured provisions. It provides explicit instructions for completing the ACORD Certificate of Liability Insurance form, emphasizing the need for precise documentation that includes only project/contract details, contract numbers, and a specific additional insured statement.
The template includes critical instructions for insurance documentation, such as requiring policy limits that meet or exceed contract requirements, ensuring policy start dates precede the contract effective date, and prohibiting qualifying language like "subject to policy terms" or "if required per contract." The document warns that any deviation from these specifications will result in certificate rejection, with the City and County of Denver reserving the right to select alternative contractors if insurance requirements cannot be precisely met. The template serves as a standardized guide to help contractors correctly prepare and submit insurance certificates for municipal contract opportunities.
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Text version
City and County of Denver Contractor
DENVER
THE MILE HIGH CITY
Certificate of Insurance
Contractors, please provide this sample certificate to your insurance agent or broker
Certificates must mirror this sample
Note the Additional Insured special instructions below
Contractor’s Legal Name
Types of insurance required in contract
If other insurance (Builders’ Risk, Professional Liability, for example) is required, please list it here
Only project/contract info and additional insured in this box*
Verify correct address & contact information
Tituruimo flrtcr NAmo & Adifrco U
11062)AFFORIP*O COAfl500 Cant
.,aA monO
Cctruilors to.oI Stan .ini AddYosY PalICO a ps—n’
COVERAGES CERTIFICATE NUUBER: REVISION NUMBER:
THIS ii. ... THAT TIlE POJCIES OF .* ,.,.. .. •...
IC3TED TOTWTH5TAICOIG ANT REOIJREVEIfl TERM OR COCOTION OF AMY CONTRACT OR OTHER OOCI*RIW RITE RESPECT To MUCH OHS CERTiFICATE MAY BE ISSUED OH MAY PERTAIN THE IIinURfiOICE AFFORORD BY THE POliCIES COSORRED HEREIN IS R5.ISCT TO Au. 0€ TERMS EECWUOMA AVE CONOOl4S OF SUCH POliCIES ClEATS 5HDMI MAY HAVE SEEN REELICED BY PAID CI.AJUS.
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As reuuired by written contract, the City and County olDenvcr, is Elected and Appointed Officials. Employees and Volunteers arc included us Additional Insured us respects the Commercial tieneral Liability and llnainess AtSo
ISIS
must be same or greater than
Z required in the contract
Policy start date
/ must be prior to effective date of the contract
*The ‘description’ box must only contain project/contract detail such as the contract name and number and “As required by written contract, the City and County of Denver, its Elected and Appointed Officials, Employees and Volunteers are included as Additional Insured” with regards to the appropriate policies ONLY.
QUALIFYING LANGUAGE SUCH AS “SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY”
and “IF REQUIRED PER WRITTEN CONTRACT” CAN NOT BE ADDED.
DO NOT ATTACH ADDITIONAL INSURED ENDORSEMENTS OR POLICIES
If any additional language is added to this section, the certificate will be rejected. If the requirements can not be complied with, we reserve the option to move on to another contractor
ACQRD CERTIFICATE OF LIABILITY INSURANCE I
ThIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATiON ONLY AND CONFERS NO RIGHTS UPON TEE CERTTFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY ThE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN TUE ISSUING INSURER(SI. AUThORIZED
REPRESENTATIVE OR PRODUCER. AND TEE CERTIFICATE UOLDER
IISPORIANI: A .,o m.,on n..a, ,* pnnnoG. ON polmypeat nO.515. eHAo,s.IF ,,.ornn,A,. ,.co.. USING Is Re lINen d COndfllse. .5 ON polIcy. Anile poW... may mqsSn I. pndon.mnd. A AstemaIN O0 PUB nHIRORO doss fbI noldn UgNA Is ON
Policy limits
C d C’ r . . WOULD ANY CF TIlL ABOVE DESCSISOD POLICIES BE CANCELLED I€Fii> an OUnO It THE EXPRMTIGN OATS THEREOF. NOTICE WILl. BE ECI.XUCRED WI l)tpartmeni oI — AECOWOUBEC am s.€ PoliCY PWoVEDCNS tAddee&s) - Dept Denver. (‘olorudo --
C TBU.DETD ACORO CORPORATiON. AU Ughts tRIp,V.d.
ACORD 25 1201 Q1QU) The ACORO name and logo me r.giBRr.d mains of ACORD
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