Section Name
Field Name
Field and/or Section Description
TITLE
ACORD 28 (2014/01)
Evidence of Commercial Property
Insurance
ACORD 28, Evidence of Commercial Property Insurance, is a
certificate of insurance issued as a matter of information only and confers no rights upon
the additional interest named on the certificate. The certificate does not affirmatively or
negatively amend, extend or alter the coverage afforded by the policies listed on the form.
The purpose of ACORD 28 is to provide information to an interested third party (such as a
mortgagee, loss payee or other additional interest) 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.
To provide information to an interested third party who provides mortgages or loans on
real property or business personal property insured under a Commercial Lines policy, use
ACORD 28. The 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.
To provide information to mortgagees and loss payees who provide mortgages or loans on
residential property, personal property or small commercial properties where less detail is
required by the mortgagee or loss payee, use ACORD 27, Evidence of Property
Insurance.
ACORD 28 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 Name, Contact Person
and Address
Enter text: The full name of the producer/agency.
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Section Name
Field Name
Field and/or Section Description
IDENTIFICATION SECTION
Producer Name, Contact Person
and Address
Enter text: The name of the individual at the producer's establishment that is the primary
contact.
IDENTIFICATION SECTION
Producer Name, Contact Person
and Address
Enter text: The mailing address line one of the producer/agency.
IDENTIFICATION SECTION
Producer Name, Contact Person
and Address
Enter text: The mailing address line two of the producer/agency.
IDENTIFICATION SECTION
Producer Name, Contact Person
and Address
Enter text: The mailing address city name of the producer/agency.
IDENTIFICATION SECTION
Producer Name, Contact Person
and Address
Enter code: The mailing address state or province code of the producer/agency.
IDENTIFICATION SECTION
Producer Name, Contact Person
and Address
Enter code: The mailing address postal code of the producer/agency.
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 (A/C, No)
Enter number: The fax number of the producer/agency.
IDENTIFICATION SECTION
E-Mail Address
Enter text: The producer's contact person e-mail address.
IDENTIFICATION SECTION
Code
Enter code: The identification code assigned to the producer (e.g. agency or brokerage
firm) by the insurer.
IDENTIFICATION SECTION
Subcode
Enter code: The identification code assigned by the insurer to the sub-producer (e.g.
person) within a producer's office (e.g. agency or brokerage).
IDENTIFICATION SECTION
Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g.
agency or brokerage).
IDENTIFICATION SECTION
Named Insured and Address
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.
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Section Name
Field Name
Field and/or Section Description
IDENTIFICATION SECTION
Additional Named Insured(s)
Enter text: The named insured(s) as it/they will appear on the policy declarations page.
IDENTIFICATION SECTION
Company Name and Address
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.
IDENTIFICATION SECTION
Enter text: The first line of the insurer's mailing address.
IDENTIFICATION SECTION
Enter text: The second line of the insurer's mailing address.
IDENTIFICATION SECTION
Enter text: The city of the insurer's mailing address.
IDENTIFICATION SECTION
Enter code: The state or province of the insurer's mailing address.
IDENTIFICATION SECTION
Enter code: The postal code of the insurer's mailing address.
IDENTIFICATION SECTION
NAIC No.
Enter code: The identification code assigned to the insurer by the NAIC.
IDENTIFICATION SECTION
Policy Type
Enter text: The type of policy issued to the insured (e. g., personal auto, truckers, garage
liability, commercial property, builders risk, etc.).
IDENTIFICATION SECTION
Loan Number
Enter identifier: The loan number, account number or other controlling number that the
additional interest may have assigned the insured.
IDENTIFICATION SECTION
Policy Number
Enter identifier: The identifier assigned by the insurer to the 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.
IDENTIFICATION SECTION
Effective Date
Enter date: The effective date of the policy. The date that the terms and conditions of the
policy commence.
IDENTIFICATION SECTION
Expiration Date
Enter date: The date on which the terms and conditions of the policy will expire.
IDENTIFICATION SECTION
Continued Until Terminated if
Checked
Check the box (if applicable): Indicates the policy was issued on a continuous basis.
IDENTIFICATION SECTION
This Replaces Prior Evidence
Dated
Enter date: The date the prior Evidence of Property Insurance, which this form replaces,
was issued to this additional interest.
PROPERTY INFORMATION Building (checkbox)
Check the box (if applicable): Indicates that Building Coverage applies.
PROPERTY INFORMATION Business Personal Property
Check the box (if applicable): Indicates that Business Personal Property Coverage applies.
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Section Name
Field Name
Field and/or Section Description
PROPERTY INFORMATION Location/Description
Enter text: The first address line of the physical location.
PROPERTY INFORMATION
Enter text: The second address line of the physical location.
PROPERTY INFORMATION
Enter text: The city of the physical location.
PROPERTY INFORMATION
Enter code: The state or province of the physical location.
PROPERTY INFORMATION
Enter code: The postal code of the physical location.
PROPERTY INFORMATION
Enter text: The description of the location used to differentiate locations such as vacant
land, apartment buildings, townhouses, single family dwellings, farms. Provide the number
of acres if farm land.
COVERAGE INFORMATION Basic
Check the box (if applicable): Indicates the type of policy/perils insured is basic.
COVERAGE INFORMATION Broad
Check the box (if applicable): Indicates the type of policy/perils insured is broad.
COVERAGE INFORMATION Special
Check the box (if applicable): Indicates the type of policy/perils insured is special.
COVERAGE INFORMATION Other Peril
Check the box (if applicable): Indicates the type of policy/perils insured is other than those
listed.
COVERAGE INFORMATION Describe Other Peril
Enter text: The description of the type of policy issued to the insured.
COVERAGE INFORMATION Amount of Insurance
Commercial Property Coverage
Enter limit: The limit applicable to the commercial property coverage.
COVERAGE INFORMATION Deductible
Enter deductible: The deductible applicable to the commercial property coverage.
COVERAGE INFORMATION Business Income
Check the box (if applicable): Indicates business income coverage applies. As used here,
if the mortgage or loan requires Business Income coverage, indicate the applicable limit,
or the number of months of coverage if coverage is provided on an actual loss sustained
basis.
COVERAGE INFORMATION Rental Value
Check the box (if applicable): Indicates rental value coverage applies. As used here, if the
mortgage or loan requires Rental Value coverage, indicate the applicable limit, or the
number of months of coverage if coverage is provided on an actual loss sustained basis.
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Section Name
Field Name
Field and/or Section Description
COVERAGE INFORMATION Yes
Business Income Or Rental Value -
Check the box (if applicable): Indicates business income or rental value coverage exists.
COVERAGE INFORMATION Limit
Business Income Or Rental Value
Enter limit: The limit applicable to the business income or rental value coverage.
COVERAGE INFORMATION Actual Loss Sustained Checkbox
Check the box (if applicable): Indicates the coverage is on an actual loss sustained basis.
COVERAGE INFORMATION Months
Actual Loss Sustained Number Of
Enter number: The number of months of coverage.
COVERAGE INFORMATION No
Business Income Or Rental Value -
Check the box (if applicable): Indicates business income or rental value coverage does not
exist.
COVERAGE INFORMATION NA
Business Income Or Rental Value -
Check the box (if applicable): Indicates business income or rental value coverage is not
applicable.
COVERAGE INFORMATION Blanket Coverage YES
Check the box (if applicable): Indicates blanket coverage exists. As used here, if yes,
indicate value(s) reported on properties identified in the Property Information section.
COVERAGE INFORMATION on property identified above
If YES, Indicate value(s) reported
Enter amount: The value for each property in accordance with the valuation method and
the subject of insurance.
COVERAGE INFORMATION Blanket Coverage No
Check the box (if applicable): Indicates blanket coverage does not exist.
COVERAGE INFORMATION Blanket Coverage N/A
Check the box (if applicable): Indicates blanket coverage is not applicable.
COVERAGE INFORMATION Terrorism Coverage YES
Check the box (if applicable): Indicates terrorism coverage exists. As used here, if yes,
attach Disclosure Notice / DEC.
COVERAGE INFORMATION Terrorism Coverage No
Check the box (if applicable): Indicates terrorism coverage does not exist.
COVERAGE INFORMATION Terrorism Coverage N/A
Check the box (if applicable): Indicates terrorism coverage is not applicable.
COVERAGE INFORMATION exclusion? Yes
Is there a terrorism-specific
Check the box (if applicable): Indicates a terrorism exclusion applies.
COVERAGE INFORMATION exclusion? No
Is there a terrorism-specific
Check the box (if applicable): Indicates a terrorism exclusion does not exist.
COVERAGE INFORMATION exclusion? N/A
Is there a terrorism-specific
Check the box (if applicable): Indicates a terrorism exclusion is not applicable.
COVERAGE INFORMATION Yes
Is domestic terrorism excluded?
Check the box (if applicable): Indicates a domestic terrorism exclusion applies.
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Section Name
Field Name
Field and/or Section Description
COVERAGE INFORMATION No
Is domestic terrorism excluded?
Check the box (if applicable): Indicates a domestic terrorism exclusion does not exist.
COVERAGE INFORMATION N/A
Is domestic terrorism excluded?
Check the box (if applicable): Indicates a domestic terrorism exclusion is not applicable.
COVERAGE INFORMATION Limited Fungus Coverage YES
Check the box (if applicable): Indicates limited fungus coverage applies. As used here, if
yes, indicate the limit for this coverage and the applicable deducible.
COVERAGE INFORMATION Limited Fungus Coverage Limit
Enter limit: The limit applicable to limited fungus coverage.
COVERAGE INFORMATION Deductible
Limited Fungus Coverage
Enter deductible: The deductible applicable to limited fungus coverage.
COVERAGE INFORMATION Limited Fungus Coverage No
Check the box (if applicable): Indicates limited fungus coverage does not exist.
COVERAGE INFORMATION Limited Fungus Coverage N/A
Check the box (if applicable): Indicates limited fungus coverage is not applicable.
COVERAGE INFORMATION Fungus Exclusion YES
Check the box (if applicable): Indicates a fungus exclusion applies. As used here, if yes,
indicate the form number, the form date and the owner (name of organization) of the form.
COVERAGE INFORMATION Form Number
Enter identifier: The number used by the insurer for this form.
COVERAGE INFORMATION Form Date
Enter date: The edition date of the form.
COVERAGE INFORMATION Name of Organization
Enter code: Indicates the entity that has copyright ownership of the form.
COVERAGE INFORMATION Fungus Exclusion No
Check the box (if applicable): Indicates a fungus exclusion does not exist.
COVERAGE INFORMATION Fungus Exclusion N/A
Check the box (if applicable): Indicates a fungus exclusion is not applicable.
COVERAGE INFORMATION Replacement Cost YES
Check the box (if applicable): Indicates replacement cost coverage exists.
COVERAGE INFORMATION Replacement Cost No
Check the box (if applicable): Indicates replacement cost coverage does not exist.
COVERAGE INFORMATION Replacement Cost N/A
Check the box (if applicable): Indicates replacement cost coverage is not applicable.
COVERAGE INFORMATION Agreed Value YES
Check the box (if applicable): Indicates a valuation type of agreed amount exists.
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Section Name
Field Name
Field and/or Section Description
COVERAGE INFORMATION Agreed Value No
Check the box (if applicable): Indicates a valuation type of agreed amount does not exist.
COVERAGE INFORMATION Agreed Value N/A
Check the box (if applicable): Indicates a valuation type of agreed amount is not
applicable.
COVERAGE INFORMATION Co-insurance YES
Check the box (if applicable): Indicates a coinsurance percentage exists. As used here, if
yes, indicate percent.
COVERAGE INFORMATION Co-insurance Percent
Enter percentage: The Coinsurance Percentage is the percentage of the total value of the
subject of insurance being insured. If the amount of insurance falls below this percentage,
the insured must share in the amount of the loss. This field should be completed even
when writing agreed amount coverage.
COVERAGE INFORMATION Co-insurance No
Check the box (if applicable): Indicates a coinsurance percentage does not exist.
COVERAGE INFORMATION Co-insurance N/A
Check the box (if applicable): Indicates a coinsurance percentage is not applicable.
COVERAGE INFORMATION applicable) YES
Equipment Breakdown (If
Check the box (if applicable): Indicates equipment breakdown coverage exists. As used
here, if yes, indicate the limit for this coverage and the applicable deductible.
COVERAGE INFORMATION Equipment Breakdown Limit
Enter limit: The limit applicable to equipment breakdown coverage.
COVERAGE INFORMATION Equipment Breakdown Deductible
Enter deductible: The deductible applicable to equipment breakdown coverage.
COVERAGE INFORMATION Equipment Breakdown No
Check the box (if applicable): Indicates equipment breakdown coverage does not exist.
COVERAGE INFORMATION Equipment Breakdown N/A
Check the box (if applicable): Indicates equipment breakdown coverage is not applicable.
COVERAGE INFORMATION building YES
Ordinance or Law - Coverage for
loss to undamaged portion of
Check the box (if applicable): Indicates building ordinance or law undamaged portion of
building coverage exists. As used here, if yes, indicate the limit for this coverage and the
applicable deductible.
COVERAGE INFORMATION Bldg Limit
Ordinance or Law Coverage for
Loss to Undamaged Portion of
Enter limit: The limit applicable to building ordinance or law coverage for loss to
undamaged portion of the building.
COVERAGE INFORMATION Bldg Deductible
Ordinance or Law Coverage for
Loss to Undamaged Portion of
Enter deductible: The deductible applicable to building ordinance or law coverage for loss
to undamaged portion of the building.
COVERAGE INFORMATION undamaged portion of building No
Ordinance or Law Coverage to
Check the box (if applicable): Indicates building ordinance or law undamaged portion of
building coverage does not exist.
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Section Name
Field Name
Field and/or Section Description
COVERAGE INFORMATION undamaged portion of building N/A
Ordinance or Law Coverage to
Check the box (if applicable): Indicates building ordinance or law undamaged portion of
building coverage is not applicable.
COVERAGE INFORMATION Costs Yes
Ordinance or Law Demolition
Check the box (if applicable): Indicates building ordinance or law demolition costs
coverage exists. As used here, if yes, indicate the limit for this coverage and the applicable
deductible.
COVERAGE INFORMATION Costs Limit
Ordinance or Law Demolition
Enter limit: The limit applicable to building ordinance or law demolition costs coverage.
COVERAGE INFORMATION Costs Deductible
Ordinance or Law Demolition
Enter deductible: The deductible applicable to building ordinance or law demolition costs
coverage.
COVERAGE INFORMATION Costs No
Ordinance or Law Demolition
Check the box (if applicable): Indicates building ordinance or law demolition costs
coverage does not exist.
COVERAGE INFORMATION Costs N/A
Ordinance or Law Demolition
Check the box (if applicable): Indicates building ordinance or law demolition costs
coverage is not applicable.
COVERAGE INFORMATION Construction Yes
Ordinance or Law Increase Cost of
Check the box (if applicable): Indicates building ordinance or law increased cost of
construction coverage exists. As used here, if yes, indicate the limit for this coverage and
the applicable deductible.
COVERAGE INFORMATION Construction Limit
Ordinance or Law Increase Cost of
Enter limit: The limit applicable to building ordinance or law increased cost of construction
coverage.
COVERAGE INFORMATION Construction Deductible
Ordinance or Law Increase Cost of
Enter deductible: The deductible applicable to building ordinance or law increased cost of
construction coverage.
COVERAGE INFORMATION Construction No
Ordinance or Law Increase Cost of
Check the box (if applicable): Indicates building ordinance or law increased cost of
construction coverage does not exist.
COVERAGE INFORMATION Construction N/A
Ordinance or Law Increase Cost of
Check the box (if applicable): Indicates building ordinance or law increased cost of
construction coverage is not applicable.
COVERAGE INFORMATION Earth Movement Yes
Check the box (if applicable): Indicates earth movement coverage exists. As used here, if
yes, indicate the limit for this coverage and the applicable deductible.
COVERAGE INFORMATION Earth Movement Limit
Enter limit: The limit applicable to earth movement coverage.
COVERAGE INFORMATION Earth Movement Deductible
Enter deductible: The deductible applicable to earth movement coverage.
COVERAGE INFORMATION Earth Movement No
Check the box (if applicable): Indicates earth movement coverage does not exist.
COVERAGE INFORMATION Earth Movement N/A
Check the box (if applicable): Indicates earth movement coverage is not applicable.
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Section Name
Field Name
Field and/or Section Description
COVERAGE INFORMATION Flood Yes
Check the box (if applicable): Indicates flood coverage exists. As used here, if yes,
indicate the limit for this coverage and the applicable deductible.
COVERAGE INFORMATION Flood Limit
Enter limit: The limit applicable to flood coverage.
COVERAGE INFORMATION Flood Deductible
Enter deductible: The deductible applicable to flood coverage.
COVERAGE INFORMATION Flood No
Check the box (if applicable): Indicates flood coverage does not exist.
COVERAGE INFORMATION Flood N/A
Check the box (if applicable): Indicates flood coverage is not applicable.
COVERAGE INFORMATION Wind / Hail incl YES checkbox
Check the box (if applicable): Indicates wind/hail coverage exists.
COVERAGE INFORMATION Wind / Hail incl NO checkbox
Check the box (if applicable): Indicates wind/hail coverage does not exist.
COVERAGE INFORMATION Provisions YES
Wind / Hail Subject to Different
Check the box (if applicable): Indicates wind hail coverage is subject to different
provisions.
COVERAGE INFORMATION Provisions Limit
Wind / Hail Subject to Different
Enter limit: The limit applicable to wind/hail coverage.
COVERAGE INFORMATION Provisions Deductible
Wind / Hail Subject to Different
Enter deductible: The deductible applicable to wind/hail coverage.
COVERAGE INFORMATION Provisions No
Wind / Hail Subject to Different
Check the box (if applicable): Indicates wind hail coverage is not subject to different
provisions.
COVERAGE INFORMATION Provisions N/A
Wind / Hail Subject to Different
Check the box (if applicable): Indicates wind/hail coverage is not applicable. As used here,
indicates subject to different provisions for wind / hail coverage is not applicable.
COVERAGE INFORMATION Named Storm incl YES checkbox
Check the box (if applicable): Indicates Named Windstorm coverage is included.
COVERAGE INFORMATION Named Storm incl NO checkbox
Check the box (if applicable): Indicates Named Windstorm coverage is not included.
COVERAGE INFORMATION Provisions YES
Named Storm Subject to Different
Check the box (if applicable): Indicates the Named Windstorm coverage is subject to
different provisions.
COVERAGE INFORMATION Provisions Limit
Named Storm Subject to Different
Enter limit: The limit applicable to named windstorm coverage.
COVERAGE INFORMATION Provisions Deductible
Named Storm Subject to Different
Enter deductible: The deductible applicable to named windstorm coverage
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Section Name
Field Name
Field and/or Section Description
COVERAGE INFORMATION Provisions No
Named Storm Subject to Different
Check the box (if applicable): Indicates the Named Windstorm coverages is not subject to
different provisions.
COVERAGE INFORMATION Provisions N/A
Named Storm Subject to Different
Check the box (if applicable): Indicates subject to different provisions is not applicable for
Named Wind Storm coverage.
COVERAGE INFORMATION to loss Yes
Permission to waive subrogation
in favor of mortgage holder prior
Check the box (if applicable): Indicates the permission to waive subrogation in favor of
mortgage holder prior to loss is granted
COVERAGE INFORMATION to loss No
Permission to waive subrogation
in favor of mortgage holder prior
Check the box (if applicable): Indicates the permission to waive subrogation in favor of
mortgage holder prior to loss is not granted.
COVERAGE INFORMATION to loss N/A
Permission to waive subrogation
in favor of mortgage holder prior
Check the box (if applicable): Indicates the permission to waive subrogation in favor of
mortgage holder prior to loss is not applicable.
ADDITIONAL INTEREST
Mortgagee Checkbox
Check the box (if applicable): Indicates the additional interest type is a mortgagee.
ADDITIONAL INTEREST
Lender Loss Payable Checkbox
Check the box (if applicable): Indicates the additional interest type is a lenders loss
payable.
ADDITIONAL INTEREST
Contract of Sale Checkbox
Check the box (if applicable): Indicates the additional interest type is a contract of sale.
ADDITIONAL INTEREST
Other Checkbox
Check the box (if applicable): Indicates the additional interest is not any of the types listed
on the form.
ADDITIONAL INTEREST
Other Description
Enter text: The description of the type of interest in the item.
ADDITIONAL INTEREST
Name and Address
Enter text: The additional interest's full name.
ADDITIONAL INTEREST
Enter text: The additional interest's mailing address line one.
ADDITIONAL INTEREST
Enter text: The additional interest's mailing address line two.
ADDITIONAL INTEREST
Enter text: The additional interest's mailing address city name.
ADDITIONAL INTEREST
Enter code: The additional interest's mailing address state or province code.
ADDITIONAL INTEREST
Enter code: The additional interest's mailing address postal code.
ADDITIONAL INTEREST
Lender Servicing Agent Name and
Address
Enter text: The additional interest's full name. As used here, this is the lender servicing
agent.
ADDITIONAL INTEREST
Enter text: The additional interest's mailing address line one. As used here, this is the
lender servicing agent.
ADDITIONAL INTEREST
Enter text: The additional interest's mailing address line two. As used here, this is the
lender servicing agent.
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Section Name
Field Name
Field and/or Section Description
ADDITIONAL INTEREST
Enter text: The additional interest's mailing address city name. As used here, this is the
lender servicing agent.
ADDITIONAL INTEREST
Enter code: The additional interest's mailing address state or province code. As used here,
this is the lender servicing agent.
ADDITIONAL INTEREST
Enter code: The additional interest's mailing address postal code. As used here, this is the
lender servicing agent.
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.
REMARKS
REMARKS
Enter text: The Evidence Of Commercial Property Insurance general remarks.
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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