ACORD Forms

ACORD Forms : How to Complete a Certificate of Liability Insurance 25

ACORD 25 Instructions

Section Name Field Name Field and/or Section Description
The title of the form. ACORD 25, Certificate of Liability Insurance, is "issued as a matter of information only, and confers no rights upon the certificate holder. This certificate does not affirmatively or negatively amend, extend, or alter the coverage afforded by policies".
The above information is included in the opening statement of the form.
If the receiver of the form wants to verify that liability coverage exists on a policy and has no direct interest in the policy, use the certificate of insurance. However, if the receiver of the form does have a verifiable interest in the policy, such as an additional insured, the liability policy must be amended by endorsement, to provide the appropriate coverage for the interested party prior to issuing a certificate of insurance (since the certificate confers no rights upon the holder and does not amend the policy).
TITLE ACORD 25 (2009/09) Certificate of Liability Insurance ACORD 25 was designed to collect policy limit information based on the ISO commercial lines program. It addresses both Claims Made and Occurrence policies.

ACORD 25 (2009/09) rev. 10-30-2009 1 of 13 ACORD 25 (2009/09) rev. 10-30-2009 2 of 13

Section Name Field Name Field and/or Section Description
The purpose of the Certificate of Insurance has been the topic of frequent discussions throughout the industry. Attention centers around the true purpose of a certificate and the rights, if any, it conveys to a certificate holder.
In a 1974 court decision (United States Pipe & Foundry Co. v United States Fidelity & Guar. Co, 505 F. 2d 88 (5th Cir. 1974), the court ruled that a certificate is not a contract between the holder and the insurer. It only provides information to an interested third party that insurance is in force at the time of issuance. The court also stated: "The provision regarding notification in the event of cancellation is a mere promise, unsupported by any consideration." Although many companies provide notice of cancellation to certificate holders, they are not obliged to do so, since the holder is not a party to the contract.
TITLE The Certificate of Liability Insurance is used for most casualty situations in which the insured has requested certification to a third party of issued casualty coverages. The uses of the Certificate can include large and small contracting or manufacturing risks, lessor/lessee agreements, or other areas of liability certification.
ACORD 25 (2009/09) rev. 10-30-2009 3 of 13
Section Name Field Name Field and/or Section Description
TITLE The ACORD Certificate should be issued only in compliance with company instructions. ACORD recommends that the Certificate NOT be used in the following situations: * To waive rights * To provide information to the owner of a leased motor vehicle or the lender about both liability and physical damage coverages applying to the vehicle (ACORD 23, Automobile Certificate of Insurance, should be used for this) * To quote wording from a contract * To attach to an endorsement * To quote any wording which amends a policy unless the policy itself has been amended IMPORTANT Kansas, Kentucky, Minnesota, Missouri, North Carolina, Oklahoma and Wisconsin require the filing of certificate of insurance forms. ACORD has filed all of its certificates in these states. In these states, the text of ACORD's certificates cannot be modified, unless the modified form is filed for approval by the respective state Department of Insurance.
TITLE Additionally, virtually every other state will not allow any change in a certificate of insurance that would attempt to modify a policy unless the revised certificate is filed and approved. In these states, this form can only be changed to reflect the terms and conditions of the policy on which it is reporting. Such change(s) must be approved in advance by the insurance carrier that issued such policy.
IDENTIFICATION SECTION Date Enter date: The month/day/year on which the form is completed. (MM/DD/YYYY)
IDENTIFICATION SECTION Producer Enter text: The full name of the producer/agency.
IDENTIFICATION SECTION Enter text: The mailing address line one of the producer/agency.
ACORD 25 (2009/09) rev. 10-30-2009 4 of 13
Section Name Field Name Field and/or Section Description
IDENTIFICATION SECTION Enter text: The mailing address line two of the producer/agency.
IDENTIFICATION SECTION Enter text: The mailing address city name of the producer/agency.
IDENTIFICATION SECTION Enter code: The mailing address state or province code of the producer/agency.
IDENTIFICATION SECTION Enter code: The mailing address postal code of the producer/agency.
IDENTIFICATION SECTION Contact Name Enter text: The name of the individual at the producer's establishment that is the primary contact.
IDENTIFICATION SECTION Phone (A/C, No, Ext) Enter number: The producer's contact person's phone number. If applicable, include the area code and extension.
IDENTIFICATION SECTION Fax No. (A/C, No, Ext) Enter number: The fax number of the producer/agency.
IDENTIFICATION SECTION E-Mail Address Enter text: The producer's contact person e-mail address.
IDENTIFICATION SECTION Producer Customer ID Enter identifier: The customer's identification number assigned by the producer (e.g. agency or brokerage).
IDENTIFICATION SECTION Insured Enter text: The named insured(s) as it/they will appear on the policy declarations page.
IDENTIFICATION SECTION Enter text: The named insured's mailing address line one.
IDENTIFICATION SECTION Enter text: The named insured's mailing address line two.
IDENTIFICATION SECTION Enter text: The named insured's mailing address city name.
IDENTIFICATION SECTION Enter code: The named insured's mailing address state or province code.
IDENTIFICATION SECTION Enter code: The named insured's mailing address postal code.
INSURERS AFFORDING COVERAGE Insurer A Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer's group name or trade name. As used here, this is Insurer A.
INSURERS AFFORDING COVERAGE NAIC # Enter code: The identification code assigned to the insurer by the NAIC. As used here, this is Insurer A.
ACORD 25 (2009/09) rev. 10-30-2009 5 of 13
Section Name Field Name Field and/or Section Description
INSURERS AFFORDING COVERAGE Insurer B Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer's group name or trade name. As used here, this is Insurer B.
INSURERS AFFORDING COVERAGE NAIC # Enter code: The identification code assigned to the insurer by the NAIC. As used here, this is Insurer B.
INSURERS AFFORDING COVERAGE Insurer C Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer's group name or trade name. As used here, this is Insurer C.
INSURERS AFFORDING COVERAGE NAIC # Enter code: The identification code assigned to the insurer by the NAIC. As used here, this is Insurer C.
INSURERS AFFORDING COVERAGE Insurer D Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer's group name or trade name. As used here, this is Insurer D.
INSURERS AFFORDING COVERAGE NAIC # Enter code: The identification code assigned to the insurer by the NAIC. As used here, this is Insurer D.
INSURERS AFFORDING COVERAGE Insurer E Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer's group name or trade name. As used here, this is Insurer E.
INSURERS AFFORDING COVERAGE NAIC # Enter code: The identification code assigned to the insurer by the NAIC. As used here, this is Insurer E.
INSURERS AFFORDING COVERAGE Insurer F Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer's group name or trade name.
INSURERS AFFORDING COVERAGE NAIC # Enter code: The identification code assigned to the insurer by the NAIC.
COVERAGES Certificate Number Enter identifier: The producer assigned number for the certificate.
COVERAGES Revision Number Enter number: The producer assigned revision number for the certificate.
COVERAGE INFORMATION Insr Ltr Enter code: The Company Letter of the insurer, as identified in the "Insurers Affording Coverage" form section, associated with the commercial general liability policy.
COVERAGE INFORMATION Commercial General Liability Check the box (if applicable): Indicates the claims made or occurrence option applies for the general liability policy.
ACORD 25 (2009/09) rev. 10-30-2009 6 of 13
Section Name Field Name Field and/or Section Description
COVERAGE INFORMATION Other General Liability Coverages -Claims-Made Check the box (if applicable): Indicates the "claims made" option applies on the general liability policy.
COVERAGE INFORMATION Occur Check the box (if applicable): Indicates the general liability policy, occurrence basis applies.
COVERAGE INFORMATION Check Box Check the box (if applicable): Indicates other coverage not found on the form exists for the general liability policy.
COVERAGE INFORMATION Field Box Enter text: The description of other coverage (not the limit) on the general liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION Check Box Check the box (if applicable): Indicates other coverage not found on the form exists for the general liability policy.
COVERAGE INFORMATION Field Box Enter text: The description of other coverage (not the limit) on the general liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION General Aggregate Limit Applies Per: - Policy Check the box (if applicable): Indicates the general liability policy, general aggregate limit applies per policy.
COVERAGE INFORMATION Project Check the box (if applicable): Indicates the general liability policy, general aggregate limit applies per project.
COVERAGE INFORMATION Loc Check the box (if applicable): Indicates the general liability policy, general aggregate limit applies per location.
COVERAGE INFORMATION Addl Insr Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as an additional insured on the policy. As used here, place a check mark next to each coverage where an additional insured endorsement has been issued.
COVERAGE INFORMATION Subr Wvd Enter Y for a “Yes” response. Input N for “No” response. Indicates subrogation has been waived on the policy.
COVERAGE INFORMATION Policy Number Enter identifier: The identifier assigned by the insurer to the policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. As used here, the general liability policy number exactly as it appears on the policy, including prefix and suffix symbols.
COVERAGE INFORMATION Policy Eff (MM/DD/YYYY) Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. As used here, the general liability policy effective date.
COVERAGE INFORMATION Policy Exp (MM/DD/YYYY) Enter date: The date on which the terms and conditions of the policy will expire. As used here, the general liability policy expiration date.
ACORD 25 (2009/09) rev. 10-30-2009 7 of 13
Section Name Field Name Field and/or Section Description
COVERAGE INFORMATION Limits - Each Occurrence $ Enter limit: The general liability, each occurrence limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as found on the policy declarations page.
COVERAGE INFORMATION Damage to Rented Premises $ Enter limit: The general liability, damage to rented premises each occurrence limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as found on the policy declarations page.
COVERAGE INFORMATION Med Exp $ Enter limit: The general liability, medical expense each person limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as found on the policy declarations page.
COVERAGE INFORMATION Personal & Adv Injury Enter limit: The general liability, personal and advertising injury limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as found on the policy declarations page.
COVERAGE INFORMATION General Aggregate $ Enter limit: The general liability, general aggregate limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as found on the policy declarations page.
COVERAGE INFORMATION Products- Comp/Op Agg $ Enter limit: The general liability, products and completed operations aggregate limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as found on the policy declarations page.
COVERAGE INFORMATION Other Limits Enter text: The description of other coverage (not the limit). Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION Other Occurrence $ Enter limit: The general liability, other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION Insr Ltr Enter code: The Company Letter of the insurer, as identified in the "Insurers Affording Coverage" form section, associated with the commercial vehicle policy.
ACORD 25 (2009/09) rev. 10-30-2009 8 of 13
Section Name Field Name Field and/or Section Description
COVERAGE INFORMATION Automobile Liability - Any Auto Check the box (if applicable): Indicates the commercial vehicle policy covers any auto. As used here, complete this section only if you are certifying automobile liability. Check all appropriate boxes to correspond with the covered auto symbols found on the policy declarations page. If the certificate is being issued to the owner of a leased vehicle, DO NOT USE THIS FORM. Use ACORD 23, Automobile Certificate of Insurance.
COVERAGE INFORMATION All Owned Autos Check the box (if applicable): Indicates the commercial vehicle policy covers all owned autos.
COVERAGE INFORMATION Scheduled Autos Check the box (if applicable): Indicates the vehicle policy covers scheduled autos.
COVERAGE INFORMATION Hired Autos Check the box (if applicable): Indicates the vehicle policy covers hired autos.
COVERAGE INFORMATION Non- Owned Autos Check the box (if applicable): Indicates the vehicle policy covers non-owned autos.
COVERAGE INFORMATION Check Box Check the box (if applicable): Indicates other coverage not found on the form exists for the vehicle policy.
COVERAGE INFORMATION Field Box Enter text: The description of other coverage (not the limit) on the vehicle policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION Addl Insr Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as an additional insured on the policy. As used here, place a check mark next to each coverage where an additional insured endorsement has been issued.
COVERAGE INFORMATION Subr Wvd Enter Y for a “Yes” response. Input N for “No” response. Indicates subrogation has been waived on the policy.
COVERAGE INFORMATION Policy Number Enter identifier: The identifier assigned by the insurer to the policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. As used here, the automobile liability policy number.
COVERAGE INFORMATION Policy Eff (MM/DD/YYYY) Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. As used here, the automobile policy effective date.
COVERAGE INFORMATION Policy Exp (MM/DD/YYYY) Enter date: The date on which the terms and conditions of the policy will expire. As used here, the automobile policy expiration date.
ACORD 25 (2009/09) rev. 10-30-2009 9 of 13
Section Name Field Name Field and/or Section Description
COVERAGE INFORMATION Combined Single Limit $ Enter limit: The vehicle combined single limit liability each accident amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as found on the policy declarations page.
COVERAGE INFORMATION Bodily Injury (Per Person) $ Enter limit: The vehicle policy, bodily injury per person limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as found on the policy declarations page.
COVERAGE INFORMATION Bodily Injury (Per Accident) $ Enter limit: The vehicle policy, bodily injury per accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION Property Damage Enter limit: The vehicle policy, property damage per accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as found on the policy declarations page.
COVERAGE INFORMATION Other Description Enter text: The description of the coverage.
COVERAGE INFORMATION Other Limit Enter limit: The limit amount of the other coverage.
COVERAGE INFORMATION Other Description Enter text: The description of the coverage.
COVERAGE INFORMATION Other Limit Enter limit: The limit amount of the other coverage.
COVERAGE INFORMATION Insr Ltr Enter code: The Company Letter of the insurer, as identified in the "Insurers Affording Coverage" form section, associated with the commercial excess umbrella liability policy.
COVERAGE INFORMATION Umbrella Liab Check the box (if applicable): Indicates the type of policy is umbrella.
COVERAGE INFORMATION Excess Liab Check the box (if applicable): Indicates the type of policy is excess.
COVERAGE INFORMATION Type of Insurance -Excess/Umbrella Liability - Occur Check the box (if applicable): Indicates "coverage trigger" is on an occurrence basis on an excess or umbrella liability policy.
COVERAGE INFORMATION Claims-Made Check the box (if applicable): Indicates the "coverage trigger" is on a claims-made basis on an excess or umbrella liability policy.
ACORD 25 (2009/09) rev. 10-30-2009 10 of 13
Section Name Field Name Field and/or Section Description
COVERAGE INFORMATION Deductible Check the box (if applicable): This indicates whether a deductible or retention amount applies to the excess or umbrella liability policy.
COVERAGE INFORMATION Retention Check the box (if applicable): Indicates the excess or umbrella liability policy has an applicable deductible or retention amount.
COVERAGE INFORMATION $ Field Box Enter deductible: The excess or umbrella liability deductible or retention amount.
COVERAGE INFORMATION Addl Insr Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as an additional insured on the policy. As used here, place a check mark next to each coverage where an additional insured endorsement has been issued.
COVERAGE INFORMATION Subr Wvd Enter Y for a “Yes” response. Input N for “No” response. Indicates subrogation has been waived on the policy.
COVERAGE INFORMATION Policy Number Enter identifier: The identifier assigned by the insurer to the policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. As used here, the excess / umbrella policy number.
COVERAGE INFORMATION Policy Eff (MM/DD/YYYY) Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. As used here, the excess / umbrella policy effective date.
COVERAGE INFORMATION Policy Exp (MM/DD/YYYY) Enter date: The date on which the terms and conditions of the policy will expire. As used here, the excess / umbrella policy expiration date.
COVERAGE INFORMATION Limits - Each Occurrence $ Enter limit: The excess umbrella liability limit each occurrence limit. As used here, the limit should be listed as a whole dollar amount, as found on the policy declarations page. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION Aggregate $ Enter limit: The excess/umbrella liability aggregate limit should be listed as whole dollar amount, as found on the policy declarations page. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as whole dollar amount, as found on the policy declarations page. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION Field Box Enter text: The description of other coverage (not the limit) on the excess umbrella liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the description of Other Excess / Umbrella Liability Limit as found on the policy declarations page. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
ACORD 25 (2009/09) rev. 10-30-2009 11 of 13
Section Name Field Name Field and/or Section Description
COVERAGE INFORMATION $ Field Box Enter limit: The excess umbrella liability limit other coverage limit. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as whole dollar amount, as found on the policy declarations page. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION Field Box Enter text: The description of other coverage (not the limit) on the excess umbrella liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION $ Field Box Enter limit: The excess umbrella liability limit other coverage limit. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as whole dollar amount, as found on the policy declarations page.
COVERAGE INFORMATION Insr Ltr Enter code: The Company Letter of the insurer, as identified in the "Insurers Affording Coverage" form section, associated with the commercial workers compensation and employers liability policy.
COVERAGE INFORMATION Type of Insurance -Workers Compensation and Employers' Liability - Any Proprietor/Partner/Executive/Offic er/Member Excluded? Enter Y for a “Yes” response. Input N for “No” response. Indicates whether the workers compensation and employers liability policy excludes any proprietor, partner, executive officer, or member. As used here, this question is mandatory in New Hampshire.
COVERAGE INFORMATION Subr Wvd Enter Y for a “Yes” response. Input N for “No” response. Indicates subrogation has been waived on the policy.
COVERAGE INFORMATION Policy Number Enter identifier: The identifier assigned by the insurer to the policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. As used here, the workers compensation policy number.
COVERAGE INFORMATION Policy Eff (MM/DD/YYYY) Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. As used here, the workers compensation policy effective date.
COVERAGE INFORMATION Policy Exp (MM/DD/YYYY) Enter date: The date on which the terms and conditions of the policy will expire. As used here, the workers compensation policy expiration date.
COVERAGE INFORMATION Limits - WC Statutory Limits Check the box (if applicable): Indicates that workers compensation statutory limits apply.
COVERAGE INFORMATION Limits - Other Check the box (if applicable): Indicates that additional coverage above the workers compensation statutory limits applies (permitted in some states). Describe the additional coverage in the Special Provisions section.
ACORD 25 (2009/09) rev. 10-30-2009 12 of 13
Section Name Field Name Field and/or Section Description
COVERAGE INFORMATION Field Box Enter text: The description of other coverage (not the limit) on the workers compensation and employers liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION E.L. Each Accident $ Enter limit: The workers compensation and employers liability policy, employers liability each accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION E.L. Disease- EA Employee $ Enter limit: The workers compensation and employers liability policy, employers liability disease each employee limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as found on the policy declarations page.
COVERAGE INFORMATION E.L. Disease- Policy Limit $ Enter limit: The workers compensation and employers liability policy, employers liability disease policy limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION Insr Ltr Enter code: The Company Letter of the insurer, as identified in the "Insurers Affording Coverage" form section, associated with the other policy.
COVERAGE INFORMATION Type of Insurance - Other Enter text: The description of the other policy not listed on the form.
COVERAGE INFORMATION Addl Insr Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as an additional insured on the policy. As used here, place a check mark next to each coverage where an additional insured endorsement has been issued.
COVERAGE INFORMATION Subr Wvd Enter Y for a “Yes” response. Input N for “No” response. Indicates subrogation has been waived on the policy.
COVERAGE INFORMATION Policy Number Enter identifier: The identifier assigned by the insurer to the policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. As used here, the policy number of the other policy.
COVERAGE INFORMATION Policy Eff (MM/DD/YYYY) Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. As used here, the effective date of the other policy,
COVERAGE INFORMATION Policy Exp (MM/DD/YYYY) Enter date: The date on which the terms and conditions of the policy will expire. As used here, the expiration date of the other policy.
COVERAGE INFORMATION Limits Enter limit: The other policy, coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as found on the policy declarations page.
Section Name Field Name Field and/or Section Description
COVERAGE INFORMATION Description of Operations / Locations / Vehicles / Exclusions Added by Endorsement / Special Provisions Enter text: The Certificate Of Liability Insurance general remarks. As used here, records information necessary to identify the operations, locations, vehicles, exclusions added by endorsement, and/or special provisions for which the certificate was issued.
CERTIFICATE HOLDER Certificate Holder Name & Address Enter text: The certificate holder's full name.
CERTIFICATE HOLDER Enter text: The certificate holder's mailing address line one.
CERTIFICATE HOLDER Enter text: The certificate holder's mailing address line two.
CERTIFICATE HOLDER Enter text: The certificate holder's mailing address city name.
CERTIFICATE HOLDER Enter code: The certificate holder's mailing address state or province code.
CERTIFICATE HOLDER Enter code: The certificate holder's mailing address postal code.
CANCELLATION Authorized Representative Sign here: Accommodates the signature of the authorized representative (e.g. producer, agent, broker, etc.). by all companies to issue Certificates. This is required in most states. As used here, the authorized representative by all companies to issue Certificates.
Edition Date The edition identifier of the form including the form number and edition (the date is typically formatted YYYY/MM).

ACORD 25 (2009/09) rev. 10-30-2009 13 of 13

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Labels: How to Complete a Certificate of Liability Insurance 25

posted by Wayne @ 11:37 AM