Section Name
Field Name
Field and/or Section Description
TITLE
ACORD 25 (2014/01)
Certificate of Liability Insurance
ACORD 25, Certificate of Liability Insurance, is issued as a matter of
information only and confers no rights upon the certificate holder. The certificate does not
affirmatively or negatively amend, extend or alter the coverage afforded by the policies
listed on the certificate.
The purpose of the certificate is to provide information to an interested third party
regarding insurance that is in force at the time of certificate issuance. Although many
companies provide notice of cancellation to certificate holders, they are not obligated to do
so unless such requirement is set forth in the policy itself directly or by endorsement to the
policy.
If the receiver of the certificate has no direct interest in the policy but wants to verify that
liability coverage exists on a policy at the time of certificate issuance, use ACORD 25. If
the receiver of the certificate does have a verifiable interest in the policy, such as an
additional insured, the liability policy must name the receiver of the certificate as an
additional insured directly or by endorsement to provide the appropriate coverage for the
interested party prior to issuing a certificate of insurance.
ACORD 25 was designed to collect policy information based on commercial lines
programs. It addresses both Claims Made and Occurrence policies and can be used for
large and small contracting or manufacturing risks, lessor/lessee agreements, or other
areas of liability certification.
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Section Name
Field Name
Field and/or Section Description
TITLE
To provide information to the owner of a leased motor vehicle or equipment, or the lender
about both liability and physical damage or property coverages applying to a vehicle or
equipment, use ACORD 23, Vehicle or Equipment Certificate of Insurance.
The ACORD Certificate should be issued only in compliance with company instructions.
IMPORTANT:
ACORD is required to file certificates, on behalf of form users, in a number of states.
Please access the Forms Filing Requirements page on the ACORD website for details.
ACORD certificates of insurance contain statements that are reflective of what is generally
required by state laws and regulations.
IDENTIFICATION SECTION Date
Enter date: The date on which the form is completed.
IDENTIFICATION SECTION Producer
Enter text: The full name of the producer/agency.
IDENTIFICATION SECTION
Enter text: The mailing address line one of the producer/agency.
IDENTIFICATION SECTION
Enter text: The mailing address line two of the producer/agency.
IDENTIFICATION SECTION
Enter text: The mailing address city name of the producer/agency.
IDENTIFICATION SECTION
Enter code: The mailing address state or province code of the producer/agency.
IDENTIFICATION SECTION
Enter code: The mailing address postal code of the producer/agency.
IDENTIFICATION SECTION Contact Name
Enter text: The name of the individual at the producer's establishment that is the primary
contact.
IDENTIFICATION SECTION Phone (A/C, No, Ext)
Enter number: The producer's contact person's phone number. If applicable, include the
area code and extension.
IDENTIFICATION SECTION Fax No. (A/C, No, Ext)
Enter number: The fax number of the producer/agency.
IDENTIFICATION SECTION E-Mail Address
Enter text: The producer's contact person e-mail address.
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Section Name
Field Name
Field and/or Section Description
IDENTIFICATION SECTION Insured
Enter text: The named insured(s) as it/they will appear on the policy declarations page.
IDENTIFICATION SECTION
Enter text: The named insured's mailing address line one.
IDENTIFICATION SECTION
Enter text: The named insured's mailing address line two.
IDENTIFICATION SECTION
Enter text: The named insured's mailing address city name.
IDENTIFICATION SECTION
Enter code: The named insured's mailing address state or province code.
IDENTIFICATION SECTION
Enter code: The named insured's mailing address postal code.
INSURERS AFFORDING
COVERAGE
Insurer A
Enter text: The insurer's full legal company name(s) as found in the file copy of the policy.
Use the actual name of the company within the group to which the policy has been issued.
This is not the insurer's group name or trade name. As used here, this is Insurer A.
INSURERS AFFORDING
COVERAGE
NAIC #
Enter code: The identification code assigned to the insurer by the NAIC. As used here,
this is Insurer A.
INSURERS AFFORDING
COVERAGE
Insurer B
Enter text: The insurer's full legal company name(s) as found in the file copy of the policy.
Use the actual name of the company within the group to which the policy has been issued.
This is not the insurer's group name or trade name. As used here, this is Insurer B.
INSURERS AFFORDING
COVERAGE
NAIC #
Enter code: The identification code assigned to the insurer by the NAIC. As used here,
this is Insurer B.
INSURERS AFFORDING
COVERAGE
Insurer C
Enter text: The insurer's full legal company name(s) as found in the file copy of the policy.
Use the actual name of the company within the group to which the policy has been issued.
This is not the insurer's group name or trade name. As used here, this is Insurer C.
INSURERS AFFORDING
COVERAGE
NAIC #
Enter code: The identification code assigned to the insurer by the NAIC. As used here,
this is Insurer C.
INSURERS AFFORDING
COVERAGE
Insurer D
Enter text: The insurer's full legal company name(s) as found in the file copy of the policy.
Use the actual name of the company within the group to which the policy has been issued.
This is not the insurer's group name or trade name. As used here, this is Insurer D.
INSURERS AFFORDING
COVERAGE
NAIC #
Enter code: The identification code assigned to the insurer by the NAIC. As used here,
this is Insurer D.
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Section Name
Field Name
Field and/or Section Description
INSURERS AFFORDING
COVERAGE
Insurer E
Enter text: The insurer's full legal company name(s) as found in the file copy of the policy.
Use the actual name of the company within the group to which the policy has been issued.
This is not the insurer's group name or trade name. As used here, this is Insurer E.
INSURERS AFFORDING
COVERAGE
NAIC #
Enter code: The identification code assigned to the insurer by the NAIC. As used here,
this is Insurer E.
INSURERS AFFORDING
COVERAGE
Insurer F
Enter text: The insurer's full legal company name(s) as found in the file copy of the policy.
Use the actual name of the company within the group to which the policy has been issued.
This is not the insurer's group name or trade name. As used here, this is Insurer F.
INSURERS AFFORDING
COVERAGE
NAIC #
Enter code: The identification code assigned to the insurer by the NAIC. As used here,
this is Insurer F.
COVERAGE INFORMATION Certificate Number
Enter identifier: The producer assigned number for the certificate.
COVERAGES
Revision Number
Enter number: The producer assigned revision number for the certificate.
COVERAGE INFORMATION Insr Ltr
Enter code: The Company Letter of the insurer, as identified in the Insurer(s) Affording
Coverage form section, associated with the commercial general liability policy.
COVERAGE INFORMATION Commercial General Liability
Check the box (if applicable): Indicates the claims made or occurrence option applies for
the general liability policy.
COVERAGE INFORMATION Claims-Made
Other General Liability Coverages -
Check the box (if applicable): Indicates the claims made option applies on the general
liability policy.
COVERAGE INFORMATION Occur
Check the box (if applicable): Indicates the general liability policy, occurrence basis
applies.
COVERAGE INFORMATION Check Box
Check the box (if applicable): Indicates other coverage not found on the form exists for the
general liability policy.
COVERAGE INFORMATION Field Box
Enter text: The description of other coverage (not the limit) on the general liability policy.
Any questions about appropriate limits or applicable policy coverage(s) should be
answered by the issuing insurer(s).
COVERAGE INFORMATION Check Box
Check the box (if applicable): Indicates other coverage not found on the form exists for the
general liability policy.
COVERAGE INFORMATION Field Box
Enter text: The description of other coverage (not the limit) on the general liability policy.
Any questions about appropriate limits or applicable policy coverage(s) should be
answered by the issuing insurer(s).
COVERAGE INFORMATION Per: - Policy
General Aggregate Limit Applies
Check the box (if applicable): Indicates the general liability policy, general aggregate limit
applies per policy.
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Section Name
Field Name
Field and/or Section Description
COVERAGE INFORMATION Project
Check the box (if applicable): Indicates the general liability policy, general aggregate limit
applies per project.
COVERAGE INFORMATION Loc
Check the box (if applicable): Indicates the general liability policy, general aggregate limit
applies per location.
COVERAGE INFORMATION Other checkbox
Check the box (if applicable): Indicates the general liability policy, general aggregate limit
applies to code is other than those listed.
COVERAGE INFORMATION Other Description
Enter code: The limit applies to code for the general liability policy, general aggregate limit.
COVERAGE INFORMATION Addl Insd
Enter Y for a Yes response. Input N for No response. Indicates if the certificate holder
has been named as an additional insured on the general liability policy.
COVERAGE INFORMATION Subr Wvd
Enter Y for a Yes response. Input N for No response. Indicates if subrogation has been
waived on the general liability policy.
COVERAGE INFORMATION Policy Number
Enter identifier: The identifier assigned by the insurer to the general liability policy, or
submission, being referenced exactly as it appears on the policy, including prefix and
suffix symbols. If required for self-insurance, the self-insured license or contract number.
COVERAGE INFORMATION Policy Eff (MM/DD/YYYY)
Enter date: The effective date of the general liability policy. The date that the terms and
conditions of the policy commence.
COVERAGE INFORMATION Policy Exp (MM/DD/YYYY)
Enter date: The date on which the terms and conditions of the general liability policy will
expire.
COVERAGE INFORMATION Limits - Each Occurrence $
Enter limit: The general liability, each occurrence limit amount. Any questions about
appropriate limits or applicable policy coverage(s) should be answered by the issuing
insurer(s). As used here, the limit should be listed as a whole dollar amount, as found on
the policy declarations page.
COVERAGE INFORMATION Damage to Rented Premises $
Enter limit: The general liability, damage to rented premises each occurrence limit
amount. Any questions about appropriate limits or applicable policy coverage(s) should be
answered by the issuing insurer(s). As used here, the limit should be listed as a whole
dollar amount, as found on the policy declarations page.
COVERAGE INFORMATION Med Exp $
Enter limit: The general liability, medical expense each person limit amount. Any questions
about appropriate limits or applicable policy coverage(s) should be answered by the
issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as
found on the policy declarations page.
COVERAGE INFORMATION Personal & Adv Injury
Enter limit: The general liability, personal and advertising injury limit amount. Any
questions about appropriate limits or applicable policy coverage(s) should be answered by
the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as
found on the policy declarations page.
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Section Name
Field Name
Field and/or Section Description
COVERAGE INFORMATION General Aggregate $
Enter limit: The general liability, general aggregate limit amount. Any questions about
appropriate limits or applicable policy coverage(s) should be answered by the issuing
insurer(s). As used here, the limit should be listed as a whole dollar amount, as found on
the policy declarations page.
COVERAGE INFORMATION Products- Comp/Op Agg $
Enter limit: The general liability, products and completed operations aggregate limit
amount. Any questions about appropriate limits or applicable policy coverage(s) should be
answered by the issuing insurer(s). As used here, the limit should be listed as a whole
dollar amount, as found on the policy declarations page.
COVERAGE INFORMATION Other Limits
Enter text: The description of other coverage (not the limit) on the general liability policy.
Any questions about appropriate limits or applicable policy coverage(s) should be
answered by the issuing insurer(s).
COVERAGE INFORMATION Other Occurrence $
Enter limit: The general liability, other coverage limit amount. Any questions about
appropriate limits or applicable policy coverage(s) should be answered by the issuing
insurer(s).
COVERAGE INFORMATION Insr Ltr
Enter code: The Company Letter of the insurer, as identified in the Insurer(s) Affording
Coverage form section, associated with the policy.
COVERAGE INFORMATION Automobile Liability - Any Auto
Check the box (if applicable): Indicates the commercial vehicle policy covers any auto. As
used here, complete this section only if you are certifying automobile liability. Check all
appropriate boxes to correspond with the covered auto symbols found on the policy
declarations page. If the certificate is being issued to the owner of a leased vehicle, DO
NOT USE THIS FORM. Use ACORD 23, Vehicle or Equipment Certificate of Insurance.
COVERAGE INFORMATION All Owned Autos
Check the box (if applicable): Indicates the commercial vehicle policy covers all owned
autos.
COVERAGE INFORMATION Hired Autos
Check the box (if applicable): Indicates the vehicle policy covers hired autos.
COVERAGE INFORMATION Other Covered Auto
Check the box (if applicable): Indicates the vehicle policy covers autos other than those
listed.
COVERAGE INFORMATION Other Covered Auto Description
Enter text: The description of the other covered autos.
COVERAGE INFORMATION Scheduled Autos
Check the box (if applicable): Indicates the vehicle policy covers scheduled autos.
COVERAGE INFORMATION Non- Owned Autos
Check the box (if applicable): Indicates the vehicle policy covers non-owned autos.
COVERAGE INFORMATION Other Covered Auto
Check the box (if applicable): Indicates the vehicle policy covers autos other than those
listed.
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Section Name
Field Name
Field and/or Section Description
COVERAGE INFORMATION Other Covered Auto Description
Enter text: The description of the other covered autos.
COVERAGE INFORMATION Addl Insd
Enter Y for a Yes response. Input N for No response. Indicates if the certificate holder
has been named as an additional insured on the automobile liability policy.
COVERAGE INFORMATION Subr Wvd
Enter Y for a Yes response. Input N for No response. Indicates if subrogation has been
waived on the automobile policy.
COVERAGE INFORMATION Policy Number
Enter identifier: The identifier assigned by the insurer to the automobile liability policy, or
submission, being referenced exactly as it appears on the policy, including prefix and
suffix symbols. If required for self-insurance, the self-insured license or contract number.
COVERAGE INFORMATION Policy Eff (MM/DD/YYYY)
Enter date: The effective date of the automobile liability policy. The date that the terms
and conditions of the policy commence.
COVERAGE INFORMATION Policy Exp (MM/DD/YYYY)
Enter date: The date on which the terms and conditions of the automobile liability policy
will expire.
COVERAGE INFORMATION Combined Single Limit $
Enter limit: The vehicle combined single limit liability each accident amount. Any questions
about appropriate limits or applicable policy coverage(s) should be answered by the
issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as
found on the policy declarations page.
COVERAGE INFORMATION Bodily Injury (Per Person) $
Enter limit: The vehicle policy, bodily injury per person limit amount. Any questions about
appropriate limits or applicable policy coverage(s) should be answered by the issuing
insurer(s). As used here, the limit should be listed as a whole dollar amount, as found on
the policy declarations page.
COVERAGE INFORMATION Bodily Injury (Per Accident) $
Enter limit: The vehicle policy, bodily injury per accident limit amount. Any questions about
appropriate limits or applicable policy coverage(s) should be answered by the issuing
insurer(s).
COVERAGE INFORMATION Property Damage
Enter limit: The vehicle policy, property damage per accident limit amount. Any questions
about appropriate limits or applicable policy coverage(s) should be answered by the
issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as
found on the policy declarations page.
COVERAGE INFORMATION Other Description
Enter text: The description of the coverage.
COVERAGE INFORMATION Other Limit
Enter limit: The limit amount of the other coverage.
COVERAGE INFORMATION Insr Ltr
Enter code: The Company Letter of the insurer, as identified in the Insurer(s) Affording
Coverage form section, associated with the commercial excess umbrella liability policy.
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Section Name
Field Name
Field and/or Section Description
COVERAGE INFORMATION Umbrella Liab
Check the box (if applicable): Indicates the type of policy is umbrella.
COVERAGE INFORMATION Excess Liab
Check the box (if applicable): Indicates the type of policy is excess.
COVERAGE INFORMATION Excess/Umbrella Liability - Occur
Type of Insurance -
Check the box (if applicable): Indicates coverage trigger is on an occurrence basis on an
excess or umbrella liability policy.
COVERAGE INFORMATION Claims-Made
Check the box (if applicable): Indicates the coverage trigger is on a claims-made basis
on an excess or umbrella liability policy.
COVERAGE INFORMATION Deductible
Check the box (if applicable): This indicates whether a deductible or retention amount
applies to the excess or umbrella liability policy.
COVERAGE INFORMATION Retention
Check the box (if applicable): Indicates the excess or umbrella liability policy has an
applicable deductible or retention amount.
COVERAGE INFORMATION $ Field Box
Enter deductible: The excess or umbrella liability deductible or retention amount.
COVERAGE INFORMATION Addl Insd
Enter Y for a Yes response. Input N for No response. Indicates if the certificate holder
has been named as an additional insured on the umbrella/excess liability policy. Place a
Y next to each coverage where an additional insured endorsement has been issued or
for umbrella / excess where there is an additional insured on the underlying primary policy
and this umbrella / excess is follow form.
COVERAGE INFORMATION Subr Wvd
Enter Y for a Yes response. Input N for No response. Indicates if subrogation has been
waived on the excess policy. For umbrella / excess, place a Y next to each coverage
where subrogation has been waived on the underlying primary policy and this umbrella /
excess is follow form.
COVERAGE INFORMATION Policy Number
Enter identifier: The identifier assigned by the insurer to the excess liability policy, or
submission, being referenced exactly as it appears on the policy, including prefix and
suffix symbols. If required for self-insurance, the self-insured license or contract number.
COVERAGE INFORMATION Policy Eff (MM/DD/YYYY)
Enter date: The effective date of the excess liability policy. The date that the terms and
conditions of the policy commence.
COVERAGE INFORMATION Policy Exp (MM/DD/YYYY)
Enter date: The date on which the terms and conditions of the excess liability policy will
expire.
COVERAGE INFORMATION Limits - Each Occurrence $
Enter limit: The excess umbrella liability limit each occurrence limit. As used here, the limit
should be listed as a whole dollar amount, as found on the policy declarations page. Any
questions about appropriate limits or applicable policy coverage(s) should be answered by
the issuing insurer(s).
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Section Name
Field Name
Field and/or Section Description
COVERAGE INFORMATION Aggregate $
Enter limit: The excess/umbrella liability aggregate limit should be listed as whole dollar
amount, as found on the policy declarations page. Any questions about appropriate limits
or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION Field Box
Enter text: The description of other coverage (not the limit) on the excess umbrella liability
policy. Any questions about appropriate limits or applicable policy coverage(s) should be
answered by the issuing insurer(s).
COVERAGE INFORMATION $ Field Box
Enter limit: The excess umbrella liability limit other coverage limit should be listed as a
whole dollar amount, as found on the policy declarations page. Any questions about
appropriate limits or applicable policy coverage(s) should be answered by the issuing
insurer(s).
COVERAGE INFORMATION Insr Ltr
Enter code: The Company Letter of the insurer, as identified in the Insurer(s) Affording
Coverage form section, associated with the commercial workers compensation and
employers liability policy.
COVERAGE INFORMATION er/Member Excluded?
Type of Insurance - Workers
Compensation and Employers'
Liability - Any
Proprietor/Partner/Executive/Offic
Enter Y for a Yes response. Input N for No response. Indicates whether the workers
compensation and employers liability policy excludes any proprietor, partner, executive
officer, or member. As used here, the DESCRIPTION OF OPERATIONS section is
available, if needed, to provide details of any Yes response. In NH, if Yes response is
indicated, it is mandatory to provide corresponding details in the DESCRIPTION OF
OPERATIONS section.
COVERAGE INFORMATION Subr Wvd
Enter Y for a Yes response. Input N for No response. Indicates if subrogation has been
waived on the workers compensation policy.
COVERAGE INFORMATION Policy Number
Enter identifier: The identifier assigned by the insurer to the workers compensation and
employers liability policy, or submission, being referenced exactly as it appears on the
policy, including prefix and suffix symbols. If required for self-insurance, the self-insured
license or contract number.
COVERAGE INFORMATION Policy Eff (MM/DD/YYYY)
Enter date: The effective date of the workers compensation and employers liability policy.
The date that the terms and conditions of the policy commence. .
COVERAGE INFORMATION Policy Exp (MM/DD/YYYY)
Enter date: The date on which the terms and conditions of the workers compensation and
employers liability policy will expire.
COVERAGE INFORMATION Limits - Per Statute
Check the box (if applicable): Indicates that workers compensation coverage is per
statute.
COVERAGE INFORMATION Limits - Other
Check the box (if applicable): Indicates that additional coverage above the workers
compensation statutory limits applies (permitted in some states).
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Section Name
Field Name
Field and/or Section Description
COVERAGE INFORMATION Field Box
Enter text: The description of other coverage (not the limit) on the workers compensation
and employers liability policy. Any questions about appropriate limits or applicable policy
coverage(s) should be answered by the issuing insurer(s). As used here, the
DESCRIPTION OF OPERATIONS section is available if more space is required.
COVERAGE INFORMATION E.L. Each Accident $
Enter limit: The workers compensation and employers liability policy, employers liability
each accident limit amount. Any questions about appropriate limits or applicable policy
coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION E.L. Disease- EA Employee $
Enter limit: The workers compensation and employers liability policy, employers liability
disease each employee limit amount. Any questions about appropriate limits or applicable
policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit
should be listed as a whole dollar amount, as found on the policy declarations page.
COVERAGE INFORMATION E.L. Disease- Policy Limit $
Enter limit: The workers compensation and employers liability policy, employers liability
disease policy limit amount. Any questions about appropriate limits or applicable policy
coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION Insr Ltr
Enter code: The Company Letter of the insurer, as identified in the Insurer(s) Affording
Coverage form section, associated with the other policy.
COVERAGE INFORMATION Type of Insurance - Other
Enter text: The description of the other policy not listed on the form.
COVERAGE INFORMATION Addl Insd
Enter Y for a Yes response. Input N for No response. Indicates if the certificate holder
has been named as an additional insured on the other policy.
COVERAGE INFORMATION Subr Wvd
Enter Y for a Yes response. Input N for No response. Indicates subrogation has been
waived on the other policy.
COVERAGE INFORMATION Policy Number
Enter identifier: The other policy number exactly as it appears on the policy, including
prefix and suffix symbols.
COVERAGE INFORMATION Policy Eff (MM/DD/YYYY)
Enter date: The date on which the terms and conditions of the other policy commence.
COVERAGE INFORMATION Policy Exp (MM/DD/YYYY)
Enter date: The date on which the terms and conditions of the other policy expires.
COVERAGE INFORMATION Limits
Enter limit: The other policy, coverage limit amount. Any questions about appropriate limits
or applicable policy coverage(s) should be answered by the issuing insurer(s). As used
here, the limit should be listed as a whole dollar amount, as found on the policy
declarations page.
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Section Name
Field Name
Field and/or Section Description
COVERAGE INFORMATION Locations / Vehicles
Description of Operations /
Enter text: The Certificate Of Liability Insurance general remarks. The additional
comments or special conditions that may exist upon the policy. ACORD 101, Additional
Remarks Schedule, may be attached if more space is required. As used here, records
information necessary to identify the operations, locations and vehicles for which the
certificate was issued.
CERTIFICATE HOLDER
Certificate Holder Name & Address
Enter text: The certificate holder's full name.
CERTIFICATE HOLDER
Enter text: The certificate holder's mailing address line one.
CERTIFICATE HOLDER
Enter text: The certificate holder's mailing address line two.
CERTIFICATE HOLDER
Enter text: The certificate holder's mailing address city name.
CERTIFICATE HOLDER
Enter code: The certificate holder's mailing address state or province code.
CERTIFICATE HOLDER
Enter code: The certificate holder's mailing address postal code.
SIGNATURE
Authorized Representative
Sign here: Accommodates the signature of the authorized representative (e.g. producer,
agent, broker, etc.) of the company(ies) listed on the document. This is required in most
states.
Edition
Date
The edition identifier of the form including the form number and edition (the date is
typically formatted YYYY/MM).
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