ACORD 25 (2016/03), Certificate of Liability Insurance Instructions

Enter the full name of the authorized representative who is signing or certifying this Certificate of Liability Insurance.

Enter the single-letter code or identifier (for example 'A') that corresponds to the insurer providing the automobile liability coverage shown on this row.

Check this box when the automobile liability coverage applies to any auto.

Check this box when the automobile liability coverage applies only to autos owned by the insured.

Check this box when the automobile liability coverage applies only to autos the insured hires.

Check this box when the automobile liability coverage applies only to autos (as indicated on the form).

Enter which autos are covered under this policy row (for example 'Any Auto', 'Owned Autos Only', or 'Hired Autos Only').

Check this box when the automobile liability coverage applies only to specifically scheduled autos listed on the policy.

Check this box when the automobile liability coverage applies only to autos not owned by the insured (non‑owned autos).

Check this box when the automobile liability coverage applies to the additional autos option shown on the form.

Enter coverage specifics for scheduled or non-owned autos applicable to this policy row (for example 'Scheduled Autos' or 'Non-Owned Autos Only').

Indicate whether an additional insured is included for this coverage by entering a value such as 'Yes' or the additional insured's name; leave blank if not applicable.

Enter 'Yes' if subrogation is waived for this coverage or leave blank/enter 'No' if not waived.

Enter the insurer's policy number for the automobile liability coverage shown on this row.

Enter the effective date of the automobile liability policy for the coverage shown on this row.

Enter the expiration date of the automobile liability policy for the coverage shown on this row.

Enter the combined single limit amount that applies per accident for this automobile liability policy row.

Enter the bodily injury limit amount per person for the automobile liability coverage shown on this row.

Enter the bodily injury limit amount per accident for the automobile liability coverage shown on this row.

Enter the property damage limit amount per accident for the automobile liability coverage shown on this row.

Enter any additional limit, sub-limit or related numeric limit detail that applies to this automobile liability coverage row.

Enter the primary dollar limit amount shown in the limits column for this automobile liability coverage row.

Enter the date this Certificate of Liability Insurance is issued.

Enter the full name of the certificate holder (organization or individual) exactly as it should appear on the certificate.

Enter the city for the certificate holder's mailing address.

Enter the state or province for the certificate holder's mailing address (use the standard two-letter code if required).

Enter the ZIP or postal code for the certificate holder's mailing address.

Enter the unique identifier or policy certificate number assigned to this Certificate of Liability Insurance.

Enter the revision or version number for this certificate to indicate which revision of the document this represents.

Enter the insurer letter code associated with this coverage row (e.g., A, B, C) to identify which insurer provides the coverage.

Check this box to indicate that Commercial General Liability coverage is provided for Coverage Row 1.

Check this box if the Commercial General Liability coverage is provided on a claims-made basis. Fill only if the 'Row 1 - Commercial General Liability' is 'Yes'.

Check this box if the Commercial General Liability coverage is provided on an occurrence basis. Fill only if the 'Row 1 - Commercial General Liability' is 'Yes'.

Check this box to indicate an additional description or sub-item entry on the first supplemental line for this coverage. Fill only if the 'Row 1 - Commercial General Liability' is 'Yes'.

Enter a value to indicate whether this policy is claims-made (for example, 'Yes' if Claims-Made applies), otherwise leave blank.

Check this box to indicate an additional description or sub-item entry on the second supplemental line for this coverage. Fill only if the 'Row 1 - Commercial General Liability' is 'Yes'.

Enter a value to indicate whether this policy is an occurrence form (for example, 'Yes' if Occurrence applies), otherwise leave blank.

Check this box if the general aggregate limit for this coverage applies per policy. Fill only if the 'Row 1 - Commercial General Liability' is 'Yes'.

Check this box if the general aggregate limit for this coverage applies per project. Fill only if the 'Row 1 - Commercial General Liability' is 'Yes'.

Check this box if the general aggregate limit for this coverage applies per location. Fill only if the 'Row 1 - Commercial General Liability' is 'Yes'.

Check this box to indicate that an alternate basis or other specification applies (provide details on the 'OTHER' line). Fill only if the 'Row 1 - Commercial General Liability' is 'Yes'.

If the general aggregate limit applies to an 'Other' category, specify that other designation here. Fill only if the 'Gen'l Aggregate Limit Applies Per - OTHER' is 'Yes'.

Enter a value to indicate whether Additional Insured coverage applies for this policy (for example, 'Yes' if Additional Insured applies), otherwise leave blank.

Enter a value to indicate whether subrogation is waived or other special wording applies for this policy (for example, 'Yes' if subrogation is waived), otherwise leave blank.

Enter the insurance policy number assigned by the insurer for this coverage.

Enter the effective date when this policy period begins.

Enter the expiration date when this policy period ends.

Provide the limit amount that applies to each occurrence under this commercial general liability policy.

Provide the limit amount that applies to damage to rented premises for each occurrence under this policy.

Provide the limit amount that applies to medical expenses per person under this policy.

Provide the limit amount that applies to personal and advertising injury under this policy.

Provide the general aggregate limit amount that applies for this policy.

Provide the products and completed operations aggregate limit amount for this policy.

If an 'Other' limit type is used, specify the description or label for that other limit. Fill only if the 'Gen'l Aggregate Limit Applies Per - OTHER' is 'Yes'.

Provide the amount for the 'Other' limit specified for this coverage row. Fill only if the 'Gen'l Aggregate Limit Applies Per - OTHER' is 'Yes'.

Provide a detailed description of the insured's operations, locations, and vehicles to be covered — include addresses, nature of operations, and relevant vehicle details (e.g., make/model, unit or VIN) as needed. Fill only if the 'Workers Compensation and Employers' Liability (Y/N)' is 'Yes'.

Enter a short reference code or marker used to indicate the end of the policy summary table.

Provide a concise description of the insured's operations, locations, and/or vehicles relevant to the policies listed above.

Enter the insurance policy number associated with the final coverage row of the table.

Enter the policy's effective date for the final coverage row.

Enter the policy's expiration date for the final coverage row.

Enter the monetary limit amount for the coverage in the left limits column on the final row.

Enter the monetary limit amount for the coverage in the right limits column on the final row.

Enter the employer's liability limit amount for 'Each Accident' in the left of the two limit columns. Fill only if the 'Workers Compensation and Employers Liability Y/N' is 'Y'.

Enter the employer's liability limit amount for 'Each Accident' in the right of the two limit columns. Fill only if the 'Workers Compensation and Employers Liability Y/N' is 'Y'.

Enter the employer's liability limit amount for 'Disease — Each Employee' in the left of the two limit columns. Fill only if the 'Workers Compensation and Employers Liability Y/N' is 'Y'.

Enter the employer's liability limit amount for 'Disease — Each Employee' in the right of the two limit columns. Fill only if the 'Workers Compensation and Employers Liability Y/N' is 'Y'.

Enter the employer's liability policy limit for 'Disease — Policy Limit' in the left of the two limit columns. Fill only if the 'Workers Compensation and Employers Liability Y/N' is 'Y'.

Enter the employer's liability policy limit for 'Disease — Policy Limit' in the right of the two limit columns. Fill only if the 'Workers Compensation and Employers Liability Y/N' is 'Y'.

Enter the full legal name of the insured (company or individual) exactly as it should appear on the certificate.

Enter the insured's primary street address or P.O. Box (first address line).

Enter any additional address information for the insured such as suite, floor, building, or a continuation of the street address.

Enter the city of the insured's mailing or business address.

Enter the state or province for the insured's address (use the standard two-letter postal abbreviation where applicable).

Enter the ZIP or postal code for the insured's address.

Enter the full name of the company listed as Insurer A on the certificate.

Enter the NAIC (National Association of Insurance Commissioners) company code for Insurer A.

Enter the full name of the company listed as Insurer B on the certificate.

Enter the NAIC company code for Insurer B.

Enter the full name of the company listed as Insurer C on the certificate.

Enter the NAIC company code for Insurer C.

Enter the full name of the company listed as Insurer D on the certificate.

Enter the NAIC company code for Insurer D.

Enter the full name of the company listed as Insurer E on the certificate.

Enter the NAIC company code for Insurer E.

Enter the full name of the company listed as Insurer F on the certificate.

Enter the NAIC company code for Insurer F.

Full legal name of the insurance producer or agency issuing this certificate.

First line of the producer's mailing address (street address or P.O. Box).

Second line of the producer's mailing address (e.g., suite, building or additional street information).

Additional address information for the producer such as city, county or other location details not entered above.

City for the producer's mailing address.

State abbreviation and ZIP code for the producer's mailing address.

Full name of the person at the producing agency who should be contacted regarding this certificate.

Telephone number (include area code and extension if applicable) for the producer contact.

Fax number (include area code) for the producer or contact person.

E-mail address for the producer contact where certificate-related communications should be sent.

Enter the insurer reference letter from the Insurer(s) section that identifies which insurer provides this umbrella/excess liability coverage.

Check this box when Umbrella Liability coverage is provided for the insured.

Check this box when Excess Liability coverage is provided for the insured.

Check this box when the Umbrella/Excess Liability coverage is written on an occurrence (OCCUR) basis.

Check this box when the Umbrella/Excess Liability coverage is written on a claims-made basis.

Check this box if a deductible (DED) applies to the Umbrella/Excess Liability coverage.

Check this box if a retention amount applies to the Umbrella/Excess Liability coverage.

Enter the deductible or retention amount that applies to this umbrella/excess liability coverage in dollars.

Enter Y or N to indicate whether an Additional Insured is included on this umbrella/excess liability policy.

Enter Y or N to indicate whether subrogation is waived on this umbrella/excess liability policy.

Enter the policy number for this umbrella/excess liability coverage.

Enter the effective date of the umbrella/excess liability policy.

Enter the expiration date of the umbrella/excess liability policy.

Enter the per-occurrence (Each Occurrence) limit amount for this umbrella/excess liability policy in dollars.

Enter the aggregate limit amount for this umbrella/excess liability policy in dollars.

Specify how the aggregate limit is applied (for example: POLICY, PROJECT, LOC) for this umbrella/excess liability coverage.

Enter any other specific limit amount applicable to this umbrella/excess liability coverage in dollars, if one applies.

Enter the insurer letter (A, B, C, etc.) that corresponds to the insurer providing the Workers' Compensation & Employers' Liability coverage on row 4.

Enter Yes or No to indicate whether any proprietor, partner, executive officer or member is excluded from this Workers' Compensation policy on row 4.

Enter N/A if the exclusion question for proprietors/partners/officers does not apply to this Workers' Compensation coverage on row 4.

Enter the policy number for the Workers' Compensation & Employers' Liability coverage shown on row 4.

Enter the effective date of the Workers' Compensation & Employers' Liability policy for row 4.

Enter the expiration date of the Workers' Compensation & Employers' Liability policy for row 4.

Check this box when the Workers' Compensation coverage for Coverage Row 4 is provided according to statutory requirements (per statute).

Check this box when the Workers' Compensation coverage for Coverage Row 4 is provided on an alternative basis (Other) rather than per statute.

Specify whether the Workers' Compensation limits are 'Per Statute' or enter a brief note describing the 'Other' basis for the limits shown on row 4.

Enter the Employers' Liability limit amount for 'Each Accident' for the policy on row 4.

Enter the Employers' Liability limit amount for 'Disease - Each Employee' for the policy on row 4.

Enter the Employers' Liability limit amount for 'Disease - Policy Limit' for the policy on row 4.