Acord Certificate Of Liability Insurance Form Pdf

This certificate of insurance does not constitute a contract between the issuing insurer s authorized representative or producer and the certificate holder.

Acord certificate of liability insurance form pdf. Certificate does not affirmatively or negatively amend extend or alter the coverage afforded by the policies below. 10628753 additional policies if a policy below does not include limit information refer to the. Certificate of liability insurance date mm dd yyyy ject loc pro policy gen l aggregate limit applies per. This certificate of insurance does not constitute a contract between the issuing insurer s authorized representative or producer and the certificate holder.

Effective date named insured s policy number carrier naic code agency new york construction agency customer id. The certificate of insurance on the reverse side of this form does not constitute a contact between the issuing insurer s authorized representative or producer and the certificate holder nor does it affirmatively or negatively amend extend or alter the coverage afforded by the policies listed thereon. Acord 25 form title. Property special form agreed value a enp 0439704 05 17 2020 05 17 2021 property limit 225 000.

Insured phone a c no ext. Acord 25 2001 08 if the certificate holder is an additional insured the policy ies must be endorsed. Certificate does not affirmatively or negatively amend extend or alter the coverage afforded by the policies below. Per accident ea accident n a subr wvd addl insr.

Certificate of liability insurance effective date. See certificate number. 570076078702 570076078702 aon risk services south inc. This certificate of insurance does not constitute a contract between the issuing insurer s authorized representative or producer and the certificate holder.

Acord 25 2001 08 insr. Certificate holder the acord name and logo are registered marks of acord hired autos only 24661 del prado suite 3 prendiville insurance agency cert id 11847 54 320 southern hills mid century insurance company 21687 fireman s fund insurance 21873 travelers casualty and surety 19038 lloyd s of london 16691 great american insurance co. Carrier naic code policy number agency named insured see certificate number. Acord certificate of liability insurance.

Per accident ea accident n a subr wvd addl insd. Claims made occur commercial general liability. This addendum summarizes some of the policy provisions in the referenced insurance policies and is issued as a. E mail fax a c no.

The certificate of insurance on the reverse side of this form does not constitute a contract between the issuing insurer s authorized representative or producer and the certificate holder nor. Acord 25 2016 03 the acord name and logo are registered marks of acord certificate of liability insurance.