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ACORD Form 23 Automobile Certificate
of Insurance Instructions

 

 
Section Name Field Name Field and/or Section Description
Use ACORD 23, Automobile Certificate of Insurance, to provide a coverage statement with respect to physical damage and/or liability insurance coverage to additional insured-lessors, loss payees or "Other" entities with an insurable interest in a vehicle, but only when the insurance policy covering the subject motor vehicle includes an "Additional Insured-Lessor" endorsement or a "loss payee endorsement" that contains a statement that the insurance company will send a notice to the lessor or loss payee in the event of policy termination.
TITLE ACORD 23 (2007/05) Automobile Certificate of Insurance For all other situations requiring certification of property or liability insurance or evidence of property insurance, use ACORD 24, Certificate of Property Insurance; ACORD 25, Certificate of Liability Insurance; ACORD 27, Evidence of Property Insurance; or ACORD 28, Evidence of Commercial Property Insurance.
IMPORTANT:
Kansas, Kentucky, Minnesota, Missouri, North Carolina, Oklahoma and Wisconsin require the filing of certificate of insurance forms. ACORD has filed all of its certificates in these states. In these states, the text of ACORD's certificates cannot be modified, unless the modified form is filed for approval by the respective state Departments of Insurance.
IMPORTANT Additionally, virtually every other state will not allow any change in a certificate of insurance that would attempt to modify a policy unless the revised certificate is filed and approved. In these states, this form can only be changed to reflect the terms and conditions of the policy on which it is reporting. Such change(s) must be approved in advance by the insurance carrier that issued such policy.
IDENTIFICATION SECTION Cert # Enter the certificate number assigned by the insurer.
IDENTIFICATION SECTION Date Month, Day, year on which the form is completed.
IDENTIFICATION SECTION Agency Name and address of the agency or broker issuing the form.
Telephone number of the agency or broker issuing the form. Include area code and
IDENTIFICATION SECTION Phone (A/C, No, Ext) extension, if applicable.
IDENTIFICATION SECTION Fax (A/C, No) Agency's facsimile number.

ACORD 23 (2007/05) rev. 09-04-2008 1 of 3 ACORD 23 (2007/05) rev. 09-04-2008 2 of 3 ACORD 23 (2007/05) rev. 09-04-2008 3 of 3

Section Name Field Name Field and/or Section Description
IDENTIFICATION SECTION E-Mail Address Agency's e-mail address.
IDENTIFICATION SECTION Code Identification code assigned to the agency or brokerage firm by the insurance company receiving this form.
IDENTIFICATION SECTION Sub Code If the agency or brokerage uses a sub-code identification system with the company, enter the appropriate code.
IDENTIFICATION SECTION Agency Customer ID Customer's identification number assigned by the agency or brokerage.
IDENTIFICATION SECTION Insurers Affording Coverage
IDENTIFICATION SECTION Company A Name of the company issuing the policy.
IDENTIFICATION SECTION Company B Name of the company issuing the policy.
IDENTIFICATION SECTION NAIC # Enter the NAIC number for the insurer affording coverage.
IDENTIFICATION SECTION Insured Insured's name and address as they appear on the policy declarations page.
DESCRIPTION OF AUTO Year Enter the year of the leased vehicle.
DESCRIPTION OF AUTO Make Indicate the make of the vehicle. (e.g., Ford)
DESCRIPTION OF AUTO Model Indicate the model of the vehicle. (e.g., Taurus)
DESCRIPTION OF AUTO Body Type Indicate the body type of the vehicle. (e.g., 2-door)
DESCRIPTION OF AUTO Vehicle Identification Number Indicate the vehicle identification number of the vehicle
COVERAGES Enter the coverage information for both auto liability and auto physical damage, as described on the policy declarations page.
COVERAGES Insr Ltr Enter the Company Letter of the company, as identified in the Insurers Affording Coverage section, next to the appropriate coverage(s).
COVERAGES Type Of Insurance Indicate the type of insurance.
COVERAGES Auto Liability Check this box to certify auto liability coverage. Complete the requested information.
COVERAGES Policy Number The number assigned by the insurance company for the policy.
COVERAGES Policy Effective Date Date (MM/DD/YYYY) on which the terms and conditions of the policy will commence.
COVERAGES Policy Expiration Date Date (MM/DD/YYYY) on which the terms and conditions of the policy will terminate unless renewed.
Section Name Field Name Field and/or Section Description
COVERAGES Limits All limits should be listed as whole dollar amounts. Enter limits corresponding to those found on the policy declarations page. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGES Auto Physical Damage Complete this section if you are certifying auto physical damage coverage.
COVERAGES Check boxes Check the applicable boxes for specific types of auto physical damage coverages.
COVERAGES Policy Number The number assigned by the insurance company for the policy.
COVERAGES Policy Effective Date Date (MM/DD/YYYY) on which the terms and conditions of the policy will commence.
COVERAGES Policy Expiration Date Date (MM/DD/YYYY) on which the terms and conditions of the policy will terminate unless renewed.
COVERAGES Check boxes Indicate if the limits are Actual Cash Value (ACV), Agreed Amount, Stated Amount or Other Type of Coverage Option, e.g., Replacement Cost Value (RCV). Identify the other type of coverage option.
COVERAGES Limits All limits should be listed as whole dollar amounts. Enter limits corresponding to those found on the policy declarations page. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGES Deductible Enter the applicable deductible.
COVERAGES Remarks Use this space to provide information about additional coverages (e.g., gap coverage), or special conditions included in the policy.
CERTIFICATE HOLDER Check boxes Check the applicable box to indicate if the Certificate Holder is a Lender, Lessor or other entity. Identify the other entity.
CERTIFICATE HOLDER Leased Vehicle Check this box if the vehicle is leased.
CERTIFICATE HOLDER Loan / Lease Number Enter the Loan or Lease number provided by the organization issuing the loan or lease.
CERTIFICATE HOLDER Name and Address of Lender / Lessor Name and mailing address of the individual or entity for whom the certificate is being prepared.
CANCELLATION Cancellation Statement Number of days in which the insurer will endeavor to mail a written cancellation notice. This amount is subject to approval by the company(ies).
CANCELLATION Authorized Representative Authorized representative should sign the form.