ACORD 25 (2016/03), Certificate of Liability Insurance Instructions
This form contains 129 fields organized into 20 sections, giving it a Form Complexity Index of 68/100 (complex). Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Authorized Representative | ||
| Authorized Representative | Text |
Enter the name (and, if applicable, signature text) of the authorized representative issuing this certificate.
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| Automobile Liability Coverage | ||
| Auto Insurer Letter | Text |
Enter the insurer identifier letter for the automobile liability coverage line.
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| ANY AUTO | Checkbox |
Check this box if the automobile liability coverage applies to any auto.
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| OWNED AUTOS ONLY | Checkbox |
Check this box if the automobile liability coverage applies only to autos owned by the insured.
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| HIRED AUTOS ONLY | Checkbox |
Check this box if the automobile liability coverage applies only to hired (leased/rented/borrowed) autos.
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| AUTOS ONLY | Checkbox |
Check this box if the automobile liability coverage is limited to “AUTOS ONLY” as indicated by the adjacent label in this section.
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| Covered Autos Selection (Owned/Hired) | Text |
Enter the indication(s) for which automobile liability auto options apply in the left column (e.g., any auto, owned autos only, hired autos only).
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| SCHEDULED AUTOS | Checkbox |
Check this box if the automobile liability coverage applies only to specifically scheduled/listed autos.
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| NON-OWNED AUTOS ONLY | Checkbox |
Check this box if the automobile liability coverage applies only to non-owned autos used in the insured’s business.
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| AUTOS ONLY | Checkbox |
Check this box if the automobile liability coverage is limited to “AUTOS ONLY” for the option shown directly above in this section.
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| Covered Autos Selection (Scheduled/Non-Owned) | Text |
Enter the indication(s) for which automobile liability auto options apply in the right column (e.g., scheduled autos, non-owned autos only).
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| Additional Insured (Auto) | Text |
Enter the indication of whether additional insured status applies to the automobile liability policy.
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| Subrogation Waived (Auto) | Text |
Enter the indication of whether subrogation is waived for the automobile liability policy.
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| Auto Policy Number | Text |
Enter the automobile liability insurance policy number.
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| Auto Policy Effective Date | Date |
Enter the effective date of the automobile liability policy.
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| Auto Policy Expiration Date | Date |
Enter the expiration date of the automobile liability policy.
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| Combined Single Limit (Each Accident) | Number |
Enter the combined single limit amount for each automobile liability accident.
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| Bodily Injury Limit (Per Person) | Number |
Enter the bodily injury liability limit amount per person.
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| Bodily Injury Limit (Per Accident) | Number |
Enter the bodily injury liability limit amount per accident.
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| Property Damage Limit (Per Accident) | Number |
Enter the property damage liability limit amount per accident.
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| Other Auto Limit Description | Number |
Enter a description of any other automobile liability limit shown on this line.
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| Other Auto Limit Amount | Number |
Enter the dollar amount for the other automobile liability limit described on this line.
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| Certificate and Revision Numbers | ||
| Certificate Number | Text |
Enter the unique identifier assigned to this certificate of liability insurance.
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| Revision Number | Text |
Enter the revision identifier or number for this certificate version.
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| Certificate Holder Information | ||
| Certificate Holder Name and Street Address | Text |
Enter the certificate holder’s full name and street mailing address as it should appear on the certificate.
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| Certificate Holder City | Text |
Enter the city for the certificate holder’s mailing address.
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| Certificate Holder State/Province | Text |
Enter the state or province for the certificate holder’s mailing address.
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| Certificate Holder ZIP/Postal Code | Text |
Enter the ZIP or postal code for the certificate holder’s mailing address.
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| Commercial General Liability Coverage | ||
| CGL Insurer Letter | Text |
Enter the insurer letter (e.g., A, B, C) that corresponds to the Commercial General Liability policy.
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| Commercial General Liability | Checkbox |
Check this box if Commercial General Liability (CGL) coverage is included on this certificate.
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| Claims-Made | Checkbox |
Check this box if the CGL policy provides coverage on a claims-made basis.
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| Occurrence | Checkbox |
Check this box if the CGL policy provides coverage on an occurrence basis.
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| Add'l Insured (CGL) | Checkbox |
Check this box if the CGL policy includes an Additional Insured endorsement for the certificate holder or other indicated party.
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| CGL Coverage Details Line 1 | Text |
Enter additional descriptive information for the Commercial General Liability coverage (line 1).
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| Subr Wvd (CGL) | Checkbox |
Check this box if subrogation is waived under the CGL policy for the certificate holder or other indicated party.
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| CGL Coverage Details Line 2 | Text |
Enter additional descriptive information for the Commercial General Liability coverage (line 2).
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| Gen'l Aggregate Applies Per: Policy | Checkbox |
Check this box if the CGL general aggregate limit applies per policy.
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| Gen'l Aggregate Applies Per: Project | Checkbox |
Check this box if the CGL general aggregate limit applies per project.
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| Gen'l Aggregate Applies Per: Location (Loc) | Checkbox |
Check this box if the CGL general aggregate limit applies per location.
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| Gen'l Aggregate Applies Per: Other | Checkbox |
Check this box if the CGL general aggregate limit applies on another basis (and specify it in the 'Other' space).
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| General Aggregate Applies Per - Other | Text |
If the general aggregate limit applies on a basis other than policy, project, or location, specify the basis here. Fill only if 'Gen'l Aggregate Applies Per: Other' is 'Yes'.
Depends on:
Gen'l Aggregate Applies Per: Other
|
| Additional Insured (CGL) | Text |
Enter the applicable additional insured indicator or wording for the Commercial General Liability coverage.
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| Subrogation Waived (CGL) | Text |
Enter the applicable waiver of subrogation indicator or wording for the Commercial General Liability coverage.
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| CGL Policy Number | Text |
Enter the policy number for the Commercial General Liability coverage.
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| CGL Policy Effective Date | Date |
Enter the effective date for the Commercial General Liability policy.
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| CGL Policy Expiration Date | Date |
Enter the expiration date for the Commercial General Liability policy.
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| Each Occurrence Limit | Number |
Enter the Commercial General Liability limit for each occurrence.
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| Damage to Rented Premises Limit | Number |
Enter the Commercial General Liability limit for damage to rented premises (each occurrence).
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| Medical Expense Limit | Number |
Enter the Commercial General Liability medical expense limit for any one person.
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| Personal & Advertising Injury Limit | Number |
Enter the Commercial General Liability limit for personal and advertising injury.
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| General Aggregate Limit | Number |
Enter the Commercial General Liability general aggregate limit.
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| Products-Completed Operations Aggregate Limit | Number |
Enter the Commercial General Liability products-completed operations aggregate limit.
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| CGL Additional Limit 1 | Number |
Enter an additional Commercial General Liability limit amount shown in the limits section.
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| CGL Additional Limit 2 | Number |
Enter an additional Commercial General Liability limit amount shown in the limits section.
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| DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES | ||
| Description of Operations / Locations / Vehicles | Text |
Enter any additional remarks describing the insured’s operations, job sites/locations, and/or vehicles related to the coverage shown on this certificate.
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| General | ||
| Certificate Holder Name | Text | |
| Certificate Holder Address Line 1 | Text | |
| Certificate Holder Address Line 2 | Text | |
| Insured Information | ||
| Insured Name | Text |
Enter the full legal name of the insured individual or organization.
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| Insured Address Line 1 | Text |
Enter the insured’s primary street address (e.g., building number and street).
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| Insured Address Line 2 | Text |
Enter any additional address information for the insured, such as suite, unit, or floor.
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| Insured City | Text |
Enter the city for the insured’s mailing address.
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| Insured State | Text |
Enter the state or province for the insured’s mailing address.
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| Insured ZIP/Postal Code | Text |
Enter the ZIP or postal code for the insured’s mailing address.
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| Insurer A Information | ||
| Insurer A Name | Text |
Enter the full name of Insurer A providing coverage.
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| Insurer A NAIC Number | Number |
Enter Insurer A's NAIC identification number.
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| Insurer B Information | ||
| Insurer B Name | Text |
Enter the full legal name of Insurer B providing coverage.
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| Insurer B NAIC Number | Number |
Enter the NAIC identification number for Insurer B.
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| Insurer C (Name and NAIC #) | ||
| Insurer C Name | Text |
Enter the full legal name of Insurer C providing coverage.
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| Insurer C NAIC Number | Number |
Enter the NAIC identification number for Insurer C.
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| Insurer D (Name and NAIC #) | ||
| Insurer D Name | Text |
Enter the full legal name of Insurer D providing coverage.
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| Insurer D NAIC Number | Number |
Enter the NAIC number for Insurer D.
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| Insurer E (Name and NAIC #) | ||
| Insurer E Name | Text |
Enter the full legal name of Insurer E providing coverage.
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| Insurer E NAIC Number | Number |
Enter the NAIC identification number for Insurer E.
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| Insurer F (Name and NAIC #) | ||
| Insurer F Name | Text |
Enter the full legal name of Insurer F providing coverage.
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| Insurer F NAIC Number | Number |
Enter the NAIC identification number for Insurer F.
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| Other Coverage | ||
| Insurer Letter | Text |
Enter the insurer letter (e.g., A, B, C) that corresponds to the carrier providing this other coverage.
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| Other Coverage Description | Text |
Provide the description of the other coverage, operations/locations/vehicles, or remarks associated with this entry. Fill only if 'Officers Excluded (Y/N)' is 'Yes'.
Depends on:
Officers Excluded (Y/N)
|
| Additional Insured Indicator | Text |
Enter the notation indicating whether additional insured applies for this other coverage entry.
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| Subrogation Waived Indicator | Date |
Enter the notation indicating whether subrogation is waived for this other coverage entry.
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| Policy Number | Date |
Enter the policy number for the other coverage.
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| Policy Effective Date | Date |
Enter the effective date of the other coverage policy.
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| Policy Expiration Date | Date |
Enter the expiration date of the other coverage policy.
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| Limit Description 1 | Number |
Enter the first limit label or coverage limit description for this other coverage entry.
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| Limit Amount 1 | Number |
Enter the dollar amount for the first listed limit for this other coverage entry.
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| Limit Description 2 | Number |
Enter the second limit label or coverage limit description for this other coverage entry.
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| Limit Amount 2 | Number |
Enter the dollar amount for the second listed limit for this other coverage entry.
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| Limit Description 3 | Number |
Enter the third limit label or coverage limit description for this other coverage entry.
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| Limit Amount 3 | Number |
Enter the dollar amount for the third listed limit for this other coverage entry.
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| Producer Contact Details | ||
| Producer Phone Number | Text |
Enter the producer’s phone number, including area code and any extension if applicable.
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| Producer Fax Number | Text |
Enter the producer’s fax number, including area code.
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| Producer Email Address | Text |
Enter the producer’s email address for contact regarding this certificate.
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| Producer Information | ||
| Producer Name | Text |
Enter the name of the insurance producer/agency issuing the certificate.
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| Producer Street Address | Text |
Enter the producer’s street address (including suite or unit if applicable).
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| Producer Address Line 2 | Text |
Enter any additional producer address information, such as building, floor, or attention line, if needed.
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| Producer City | Text |
Enter the city for the producer’s mailing address.
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| Producer State | Text |
Enter the state or province for the producer’s mailing address.
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| Producer ZIP/Postal Code | Text |
Enter the ZIP or postal code for the producer’s mailing address.
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| SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE | ||
| Certificate Date | Date |
Enter the date the certificate of liability insurance is issued.
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| Producer Contact Name | Text |
Enter the name of the contact person at the producer/agency listed on the certificate.
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| Umbrella / Excess Liability Coverage | ||
| Insurer Letter | Text |
Enter the insurer letter (e.g., A, B, C) corresponding to the umbrella/excess liability coverage.
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| Umbrella Liability (UMBRELLA LIAB) | Checkbox |
Check this box if the coverage being certified is an Umbrella Liability policy.
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| Excess Liability (EXCESS LIAB) | Checkbox |
Check this box if the coverage being certified is an Excess Liability policy.
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| Occurrence (OCCUR) | Checkbox |
Check this box if the umbrella/excess liability coverage is written on an occurrence basis.
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| Claims-Made (CLAIMS-MADE) | Checkbox |
Check this box if the umbrella/excess liability coverage is written on a claims-made basis.
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| Deductible Applies (DED) | Checkbox |
Check this box if the umbrella/excess liability policy has a deductible that applies.
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| Self-Insured Retention Applies (RETENTION) | Checkbox |
Check this box if the umbrella/excess liability policy includes a self-insured retention amount.
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| Deductible / Retention Amount | Number |
Enter the deductible or self-insured retention amount that applies to the umbrella/excess liability policy. Fill only if 'Deductible Applies (DED)', 'Self-Insured Retention Applies (RETENTION)' is 'Yes' (any).
Depends on:
Deductible Applies (DED), Self-Insured Retention Applies (RETENTION)
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| Additional Insured Indicator | Text |
Enter whether the umbrella/excess liability policy includes additional insured status (e.g., Y or N).
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| Subrogation Waived Indicator | Text |
Enter whether subrogation is waived for the umbrella/excess liability policy (e.g., Y or N).
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| Umbrella/Excess Policy Number | Text |
Enter the policy number for the umbrella/excess liability coverage.
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| Policy Effective Date | Date |
Enter the effective date of the umbrella/excess liability policy.
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| Policy Expiration Date | Date |
Enter the expiration date of the umbrella/excess liability policy.
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| Each Occurrence Limit | Number |
Enter the umbrella/excess liability limit that applies to each occurrence.
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| Aggregate Limit | Number |
Enter the total aggregate limit for the umbrella/excess liability coverage.
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| Other Limit Description | Text |
Enter a description of any other umbrella/excess liability limit being listed on this line.
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| Other Limit Amount | Number |
Enter the amount for the other umbrella/excess liability limit described on this line.
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| Workers Compensation / Employers Liability Coverage | ||
| WC/EL Insurer Letter | Text |
Enter the letter of the insurer providing the Workers Compensation/Employers Liability coverage (e.g., A, B, C).
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| Officers Excluded (Y/N) | Text |
Enter whether any proprietor, partner, executive officer, or member is excluded from the Workers Compensation policy.
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| WC/EL Additional Insured/Subrogation Indicator | Text |
Enter any notation for this policy’s Additional Insured and/or Subrogation Waived status (e.g., Y, N, or N/A).
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| WC/EL Policy Number | Text |
Enter the policy number for the Workers Compensation/Employers Liability coverage.
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| WC/EL Policy Effective Date | Date |
Enter the date the Workers Compensation/Employers Liability policy becomes effective.
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| WC/EL Policy Expiration Date | Date |
Enter the date the Workers Compensation/Employers Liability policy expires.
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| Per Statute | Checkbox |
Check this box if the Workers Compensation coverage limit applies per the statutory requirements of the state(s) where the work is performed.
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| Other | Checkbox |
Check this box if the Workers Compensation coverage is subject to a limit or condition other than “Per Statute” (and specify the details/limit in the space provided).
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| WC Statutory Limits Other | Text |
Enter any 'Other' statutory limits wording or reference applicable to Workers Compensation, if shown. Fill only if 'Other' is 'Yes'.
Depends on:
Other
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| EL Each Accident Limit | Number |
Enter the Employers Liability limit for each accident.
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| EL Disease Each Employee Limit | Number |
Enter the Employers Liability limit for disease for each employee.
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| EL Disease Policy Limit | Number |
Enter the Employers Liability limit for disease for the entire policy.
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