ACORD 25, Certificate of Liability Insurance Instructions
This form contains 129 fields organized into 21 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Authorized Representative | ||
| Authorized Representative Name | Text |
Please provide the name of the authorized representative.
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| Automobile Liability Coverage | ||
| Automobile Liability - Any Auto/Owned Autos Only Indicator | Text |
Enter an indicator if coverage applies for any auto or owned autos only.
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| ANY AUTO | Checkbox |
Check this box if the automobile liability coverage applies to all autos, including owned, non-owned, and hired vehicles.
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| OWNED AUTOS ONLY | Checkbox |
Check this box if the automobile liability coverage applies exclusively to autos owned by the insured.
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| HIRED AUTOS ONLY | Checkbox |
Check this box if the automobile liability coverage applies exclusively to autos hired, rented, or borrowed by the insured.
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| Second coverage row - Other (unlabeled option) | Checkbox |
Check this box only if the form specifies an additional automobile liability auto category next to/near this box that applies to the insured.
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| Automobile Liability - Hired Autos Only Indicator | Text |
Enter an indicator if coverage applies for hired autos only.
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| SCHEDULED AUTOS | Checkbox |
Check this box if the automobile liability coverage applies only to specific autos that are explicitly listed or scheduled on the policy.
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| NON-OWNED AUTOS ONLY | Checkbox |
Check this box if the automobile liability coverage applies exclusively to non-owned autos used in connection with the insured's business, such as employee-owned vehicles.
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| Second coverage row - Other (unlabeled option, right) | Checkbox |
Check this box only if the form specifies an additional automobile liability auto category next to/near this box that applies to the insured.
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| Automobile Liability - Non-Owned Autos Only Indicator | Text |
Enter an indicator if coverage applies for non-owned autos only.
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| Automobile Liability Policy Number Part 1 | Text |
Enter the first part of the automobile liability policy number.
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| Automobile Liability Policy Number Part 2 | Text |
Enter the second part of the automobile liability policy number.
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| Automobile Liability Policy Number Part 3 | Text |
Enter the third part of the automobile liability policy number.
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| Automobile Liability Policy Effective Date | Date |
Enter the effective date of the automobile liability policy.
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| Automobile Liability Policy Expiration Date | Date |
Enter the expiration date of the automobile liability policy.
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| Automobile Liability Combined Single Limit | Number |
Enter the combined single limit per accident for automobile liability.
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| Automobile Liability Bodily Injury Limit Per Person | Number |
Enter the bodily injury limit per person for automobile liability.
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| Automobile Liability Bodily Injury Limit Per Accident | Number |
Enter the bodily injury limit per accident for automobile liability.
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| Automobile Liability Property Damage Limit | Number |
Enter the property damage limit per accident for automobile liability.
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| Non-Owned Autos Only Policy Effective Date | Date |
Enter the effective date for non-owned autos only automobile liability coverage.
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| Non-Owned Autos Only Policy Expiration Date | Date |
Enter the expiration date for non-owned autos only automobile liability coverage.
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| Certificate and Revision Number | ||
| Certificate Number | Text |
Please provide the unique identification number for this certificate.
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| Revision Number | Text |
Please provide the revision number for this certificate.
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| Certificate Date | ||
| Certificate Issue Date | Date |
Enter the date the certificate of liability insurance was issued.
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| Certificate Holder | ||
| Certificate Holder Name and Address | Text |
Enter the full legal name and complete mailing address of the certificate holder.
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| Certificate Holder Reference Number | Text |
Enter any reference, loan, job, or project number associated with the certificate holder.
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| Certificate Holder Additional Identifier 1 | Text |
Enter the first additional identifier or specific code related to the certificate holder.
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| Certificate Holder Additional Identifier 2 | Text |
Enter the second additional identifier or specific code related to the certificate holder.
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| Commercial General Liability Coverage | ||
| Insurer Letter | Text |
Enter the letter corresponding to the insurer providing this commercial general liability coverage.
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| Commercial General Liability | Checkbox |
Check this box if the certificate covers Commercial General Liability insurance.
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| Claims-Made | Checkbox |
Check this box if the Commercial General Liability policy is a claims-made type of coverage.
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| Occurrence | Checkbox |
Check this box if the Commercial General Liability policy is an occurrence type of coverage.
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| Per Policy | Checkbox |
Check this box if the General Aggregate Limit for Commercial General Liability applies per policy.
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| Per Project | Checkbox |
Check this box if the General Aggregate Limit for Commercial General Liability applies per project.
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| Per Location | Checkbox |
Check this box if the General Aggregate Limit for Commercial General Liability applies per location.
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| Other | Checkbox |
Check this box if the General Aggregate Limit for Commercial General Liability applies per a method other than policy, project, or location.
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| Other General Aggregate Limit Applicability | Text |
Specify any other conditions for which the general aggregate limit applies, if not Policy, Project, or Location. Fill only if 'Other' is 'Yes'.
Depends on:
Other
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| Additional Insured | Text |
Indicate if there is an additional insured for this commercial general liability policy.
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| Subrogation Waived | Text |
Indicate if subrogation is waived for this commercial general liability policy.
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| Policy Number | Text |
Enter the policy number for the commercial general liability coverage.
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| Policy Effective Date | Date |
Enter the date when this commercial general liability policy became effective.
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| Policy Expiration Date | Date |
Enter the date when this commercial general liability policy expires.
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| Each Occurrence Limit | Number |
Enter the maximum amount payable for any single occurrence under this commercial general liability policy.
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| Damage to Rented Premises Limit | Number |
Enter the maximum amount payable for damage to rented premises per occurrence under this commercial general liability policy.
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| Medical Expense Limit | Number |
Enter the maximum amount payable for medical expenses for any one person under this commercial general liability policy.
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| Personal & Advertising Injury Limit | Number |
Enter the maximum amount payable for personal and advertising injury under this commercial general liability policy.
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| General Aggregate Limit | Number |
Enter the maximum total amount payable for all occurrences during the policy period under this commercial general liability policy.
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| Products - Completed Operations Aggregate Limit | Number |
Enter the maximum total amount payable for products and completed operations aggregate under this commercial general liability policy.
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| CGL Row 1 - Other Limit Currency/Prefix | Text |
Enter any currency symbol or prefix to display with the OTHER limit amount for this Commercial General Liability coverage.
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| Other Aggregate Limit | Number |
Enter the maximum total amount payable for the specified aggregate limit.
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| Description of Operations/Locations/Vehicles | ||
| Operations Locations Vehicles Description | Text |
Provide a detailed description of the operations, locations, and vehicles relevant to the insurance policy.
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| General | ||
| Enter text: The certificate holder's full name | Text | |
| Enter text: The certificate holder's mailing address line one | Text | |
| Enter text: The certificate holder's mailing address line two | Text | |
| Insured | ||
| Insured Name | Text |
Enter the full legal name of the insured entity or individual.
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| Insured Address Line 1 | Text |
Enter the first line of the insured's street address.
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| Insured Address Line 2 | Text |
Enter the second line of the insured's street address, if applicable.
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| Insured Address Line 3 | Text |
Enter the third line of the insured's street address, if applicable.
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| Insured City, State | Text |
Enter the city and state of the insured's address.
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| Insured Zip Code | Text |
Enter the postal zip code of the insured's address.
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| Insurer A | ||
| Insurer Name | Text |
Please provide the name of Insurer A.
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| NAIC Number | Text |
Please provide the NAIC (National Association of Insurance Commissioners) number for Insurer A.
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| Insurer B | ||
| Insurer B Name | Text |
Enter the full legal name of Insurer B providing coverage.
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| Insurer B NAIC Number | Text |
Enter the NAIC identification number for Insurer B.
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| Insurer C | ||
| Insurer C Name | Text |
Please enter the full name of Insurer C.
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| Insurer C NAIC # | Text |
Please enter the NAIC number for Insurer C.
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| Insurer D | ||
| Insurer D Company Name | Text |
Please enter the full legal name of Insurer D.
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| Insurer D NAIC Number | Text |
Please provide the NAIC number for Insurer D.
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| Insurer E | ||
| Insurer E Name | Text |
Please provide the name of Insurer E that is affording coverage.
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| Insurer E NAIC Number | Number |
Please provide the NAIC number for Insurer E.
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| Insurer F | ||
| Insurer F Name | Text |
Enter the full name of Insurer F.
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| Insurer F NAIC Number | Text |
Enter the NAIC number for Insurer F.
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| Producer | ||
| Producer Company Name | Text |
Provide the full legal name of the insurance producer or agency.
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| Producer Street Address Line 1 | Text |
Enter the primary street address for the producer.
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| Producer Street Address Line 2 | Text |
Enter any additional street address information, such as suite or apartment numbers, for the producer.
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| Producer City | Text |
Provide the city where the producer is located.
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| Producer State | Text |
Enter the two-letter state abbreviation for the producer's address.
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| Producer Zip Code | Text |
Enter the postal zip code for the producer's address.
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| Producer Contact | ||
| Contact Name | Text |
Enter the full name of the producer contact person.
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| Phone Number | Text |
Enter the phone number, including area code and extension if applicable, for the producer contact.
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| Fax Number | Text |
Enter the fax number, including area code, for the producer contact.
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| Email Address | Text |
Enter the email address for the producer contact.
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| Second Coverage Row Checkboxes | ||
| CLAIMS-MADE | Checkbox |
Check this box if the Commercial General Liability policy provides coverage on a claims-made basis.
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| Claims-Made Coverage | Text |
Indicate if the Commercial General Liability coverage is claims-made.
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| OCCUR | Checkbox |
Check this box if the Commercial General Liability policy provides coverage on an occurrence basis.
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| Occurrence Coverage | Text |
Indicate if the Commercial General Liability coverage is occurrence-based.
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| Sixth Coverage Row | ||
| Insurer Letter (E.L. Disease Policy Limit) | Text |
Enter the letter code identifying the insurer for Employer's Liability Disease Policy Limit coverage.
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| Type of Insurance (E.L. Disease Policy Limit) | Text |
Specify any additional details regarding the type of Employer's Liability Disease Policy Limit coverage. Fill only if 'Insurer Letter' is 'Yes'.
Depends on:
Insurer Letter
|
| Additional Insured (E.L. Disease Policy Limit) | Text |
Indicate if there is an additional insured for the Employer's Liability Disease Policy Limit coverage.
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| Subrogation Waived (E.L. Disease Policy Limit) | Text |
Indicate if subrogation is waived for the Employer's Liability Disease Policy Limit coverage.
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| Policy Number (E.L. Disease Policy Limit) | Text |
Enter the policy number for the Employer's Liability Disease Policy Limit coverage.
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| Policy Effective Date (E.L. Disease Policy Limit) | Date |
Enter the effective date of the Employer's Liability Disease Policy Limit coverage.
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| Policy Expiration Date (E.L. Disease Policy Limit) | Date |
Enter the expiration date of the Employer's Liability Disease Policy Limit coverage.
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| E.L. Disease Policy Limit Amount | Number |
Enter the dollar amount for the Employer's Liability Disease Policy Limit.
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| E.L. Disease Policy Other Limit | Number |
Enter any other specific limit amount for the Employer's Liability Disease coverage.
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| Insurer Letter (Additional Coverage Row 1) | Text |
Enter the letter code identifying the insurer for the first additional coverage row.
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| Type of Insurance (Additional Coverage Row 1) | Number |
Specify the type of insurance for the first additional coverage row.
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| Limit Amount (Additional Coverage Row 2) | Number |
Enter the main dollar amount limit for the second additional coverage row.
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| Other Limit Amount (Additional Coverage Row 2) | Number |
Enter any other specific dollar amount limit for the second additional coverage row.
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| Umbrella/Excess Liability Coverage | ||
| Excess Liability Insurer Letter | Text |
Enter the insurer letter code for the Excess Liability coverage.
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| Umbrella Liability | Checkbox |
Check this box if the policy provides umbrella liability coverage.
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| Excess Liability | Checkbox |
Check this box if the policy provides excess liability coverage.
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| Occurrence | Checkbox |
Check this box if the Umbrella/Excess Liability coverage is provided on an occurrence basis.
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| Claims-Made | Checkbox |
Check this box if the Umbrella/Excess Liability coverage is provided on a claims-made basis.
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| Deductible | Checkbox |
Check this box if the Umbrella/Excess Liability policy includes a deductible.
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| Retention | Checkbox |
Check this box if the Umbrella/Excess Liability policy includes a self-insured retention.
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| Excess Liability Retention Amount | Number |
Enter the deductible retention amount for the Excess Liability coverage.
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| Excess Liability Addl Subrogation Insured Waived | Text |
Indicate whether additional subrogation insured is waived for the Excess Liability coverage.
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| Excess Liability Policy Number | Text |
Enter the policy number for the Excess Liability coverage.
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| Excess Liability Policy Effective Date | Date |
Enter the effective date of the Excess Liability policy.
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| Excess Liability Policy Expiration Date | Date |
Enter the expiration date of the Excess Liability policy.
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| Excess Liability Policy Other Detail | Date |
Enter any additional details or references pertaining to the Excess Liability policy.
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| Umbrella Liability Each Occurrence Limit | Number |
Enter the monetary limit for each occurrence under Umbrella Liability coverage.
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| Umbrella Liability Aggregate Limit | Number |
Enter the total aggregate monetary limit under Umbrella Liability coverage.
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| Excess Liability Each Occurrence Limit | Number |
Enter the monetary limit for each occurrence under Excess Liability coverage.
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| Excess Liability Aggregate Limit | Number |
Enter the total aggregate monetary limit under Excess Liability coverage.
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| Workers Compensation and Employers' Liability Coverage | ||
| Insurer Letter | Text |
Enter the letter code assigned to the insurer providing the Workers Compensation and Employers' Liability coverage.
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| Excluded Parties (Y/N) | Text |
Indicate 'Y' if any proprietor, partner, executive officer, or member is excluded from Workers Compensation and Employers' Liability coverage, or 'N' if not.
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| Additional Subrogation Insured Waived | Text |
Indicate if additional insured subrogation is waived for the Workers Compensation and Employers' Liability policy.
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| Workers Comp Policy Number | Text |
Enter the policy number for the Workers Compensation and Employers' Liability coverage.
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| Policy Effective Date | Date |
Enter the effective date of the Workers Compensation and Employers' Liability policy.
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| Policy Expiration Date | Date |
Enter the expiration date of the Workers Compensation and Employers' Liability policy.
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| Per Statute | Checkbox |
Check this box if the Workers Compensation and Employers' Liability coverage limits are set according to statutory requirements.
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| Other | Checkbox |
Check this box if the Workers Compensation and Employers' Liability coverage limits are determined by a method other than by statute.
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| Other Statutory Limit | Number |
Enter the 'Other' Employers' Liability limit for claims, if applicable, as specified by statute. Fill only if 'Other' is 'Yes'.
Depends on:
Other
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| E.L. Each Accident Limit | Number |
Enter the Employers' Liability limit per accident.
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| E.L. Disease Each Employee Limit | Number |
Enter the Employers' Liability limit per employee for disease claims.
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| E.L. Disease Policy Limit | Number |
Enter the Employers' Liability policy limit for all disease claims.
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