Certificate Of Liability Insurance Form Mn

Acord 25 form title.

Certificate of liability insurance form mn. This certificate of insurance does not constitute a contract between the issuing insurer s authorized representative or producer and the certificate holder. Claims made occur commercial general liability general liability premises ea occurrence damage to rented each occurrence med exp any one person personal adv injury general aggregate. The certificate of insurance on the reverse side of this form does not constitute a contract between the issuing insurer. Certificate of liability insurance waiver of subrogation applies in favor of the certificate holder per the business liability coverage form ss0008 attached to this policy.

Around one out of every 25 claims resulting from errors and omissions involve a certificate of insurance. The completed form should be mailed to driver and vehicle services 445 minnesota street st. This is to certify that the insurance policy listed below has been issued to the named insured for the policy period indicated and that the policy meets the minimum coverage requirements applicable under minnesota statutes section 326b 86 subd. It may also be faxed to 651 297 5574.

The acord 25 certificate of liability insurance form or similar form filed with minnesota department of commerce can be used to provide evidence of general liability insurance coverage. A certificate must be submitted with an application form renewal form or when updating general liability insurance coverage. Agent broker name address. Certificate of liability insurance date mm dd yyyy ject loc pro policy gen l aggregate limit applies per.

Liability insurance an effective certificate of insurance issued by an insurance company authorized to do business in the state of minnesota by the minnesota department of commerce shows the following minimum liability coverage amounts. It also lists the dates that the policy is in effect. Form must be completed by the insurance agent or insurance company not by the business contractor. It provides evidence that the contractor has insurance coverage and includes the type of coverage and the limits of the policy.

Minnesota statutes require that before reinstatement of revoked driving privileges or revoked registration for no insurance the operator shall file a certificate of insurance with the commissioner of public safety. An minnesota certificate of insurance is a document that s standard in the contracting business. Contact us at dli license state mn us or 651 284 5034. Certificate does not affirmatively or negatively amend extend or alter the coverage afforded by the policies below.

This certificate is issued as a matter of information only and confers no rights upon the certificate holder this certificate does not amend extend or alter the coverage afforded by the policies below. Certificate holder is an additional insured per the business liability coverage form ss0008 attached to this policy. Acord 25 2001 08 if the certificate holder is an additional insured the policy ies must be endorsed. Type of insurance policy number date mm dd yy date mm dd yy limits.

The form can also be used to report workers compensation insurance coverage.