Contractor Forms - GL

  • THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

    IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).

  • Insurance Company Info

    The following pertains to your insurance company's information:
  • Insurance Company Name
  • Insurance Company Address
  • Insurance Company Contact Name
  • List Name and NAIC# for each Insurer
  • Your Company Info

    The next questions are about your company (the insured).
  • Enter your company name here
  • Your company's address
  • Coverage and Limits

    This section is about your policy coverage and limits.
  • Choose one:
  • Choose one:
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Limits

    Enter your policy limit amounts below:
  • Certificate Holder & Signature