[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-195331-105":3,"detail-sidebar-cat-1-en-105":81,"doc-detail-195331-en":127},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","certificate-of-liability-insurance-insurance-certificate-form","CERTIFICATE OF LIABILITY INSURANCE - Insurance Certificate Form","","Certificate of Liability Insurance template for documenting insurance coverage details for an insured party. Includes issuance date, producer and contact information, insurer information, policy numbers, effective and expiration dates, and coverage limits for multiple lines such as commercial general liability, automobile liability, umbrella liability, and workers compensation. Provides statements clarifying that the certificate is issued for information only and does not alter policy terms, plus guidance for additional insured status and subrogation endorsements.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/certificate-of-liability-insurance-insurance-certificate-form/195331/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/certificate-of-liability-insurance-insurance-certificate-form/195331.png","ImageObject",442,249,{"name":42,"@type":43},"Gloria","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-07","2026-09-03",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",9,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What does the certificate state about coverage and rights of the certificate holder?","Question",{"text":63,"@type":64},"It states that issuance is for information only and does not confer rights or amend, extend, or alter the coverage provided by the policies. It also states the certificate does not constitute a contract between the insurer and the certificate holder.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"Which details are included for the producer and insurers?",{"text":68,"@type":64},"The template includes producer identification, contact name, phone and fax, email address, insurer names, and NAIC number fields for multiple insurers.",{"name":70,"@type":61,"acceptedAnswer":71},"How are policy period dates and limits organized in the form?",{"text":72,"@type":64},"Coverage entries list each policy type with policy number, effective date and expiration date, and the applicable limits such as each occurrence and aggregate limits, along with other relevant limit fields per section.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},195331,1788447457,{"code":4,"msg":82,"data":83},"success",[84,89,94,99,104,109,113,118,123],{"id":85,"doc_module":22,"doc_module_name":25,"category_name":86,"show_sort_weight":87,"slug":88},11,"Presentations",90,"presentations",{"id":90,"doc_module":22,"doc_module_name":25,"category_name":91,"show_sort_weight":92,"slug":93},12,"Resumes",80,"resumes",{"id":95,"doc_module":22,"doc_module_name":25,"category_name":96,"show_sort_weight":97,"slug":98},14,"Invoices",70,"invoices",{"id":100,"doc_module":22,"doc_module_name":25,"category_name":101,"show_sort_weight":102,"slug":103},15,"Posters",60,"posters",{"id":105,"doc_module":22,"doc_module_name":25,"category_name":106,"show_sort_weight":107,"slug":108},16,"Social Media",50,"social-media",{"id":110,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":111,"slug":112},17,40,"forms",{"id":114,"doc_module":22,"doc_module_name":25,"category_name":115,"show_sort_weight":116,"slug":117},18,"Letters",30,"letters",{"id":119,"doc_module":22,"doc_module_name":25,"category_name":120,"show_sort_weight":121,"slug":122},21,"Paper Templates",5,"papers-templates",{"id":124,"doc_module":22,"doc_module_name":25,"category_name":125,"show_sort_weight":4,"slug":126},158,"General","general-158",{"code":4,"msg":82,"data":128},{"doc_id":79,"user_id":129,"nickname":42,"user_avatar":130,"doc_module":22,"category_id":110,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":22,"language":136,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":12,"update_tm":80,"read_time":4},2336474459895,"https://ap-avatar.wpscdn.com/avatar/22000baeef7a5ed0655?x-image-process=image/resize,m_fixed,w_180,h_180&k=1786071322749376916","| | CERTIFICATE OF LIABILITY INSURANCE |  |  | DATE (MM/DD/YYYY) |  |\n| --- | --- | --- | --- | --- | --- |\n| 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. |  |  |  |  |  |\n| 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) . |  |  |  |  |  |\n| PRODUCER |  | CONTACT NAME: |  |  |  |\n|  |  | PHONE\u003Cbr>(A/C, No, Ext): | FAX\u003Cbr>(A/C, No): |  |  |\n|  |  | E-MAIL ADDRESS: |  |  |  |\n|  |  | INSURER(S) AFFORDING COVERAGE |  |  | NAIC \\# |\n|  |  | INSURER A : |  |  |  |\n| INSURED |  | INSURER B : |  |  |  |\n|  |  | INSURER C : |  |  |  |\n|  |  | INSURER D : |  |  |  |\n|  |  | INSURER E : |  |  |  |\n|  |  | INSURER F : |  |  |  |\n\n\n| THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| INSR\u003Cbr>LTR | TYPE OF INSURANCE |  |  |  |  |  |  |  |  |  |  |  |  | ADDL\u003Cbr>INSD | SUBR\u003Cbr>WVD | POLICY NUMBER | POLICY EFF\u003Cbr>(MM/DD/YYYY) | POLICY EXP\u003Cbr>(MM/DD/YYYY) | LIMITS |  |  |  |  |\n|  |  | COMMERCIAL GENERAL LIABILITY |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | EACH OCCURRENCE |  |  |  | $ |\n|  |  | CLAIMS-MADE\u003Cbr>OCCUR |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | DAMAGE TO RENTED PREMISES (Ea occurrence) |  |  |  | $ |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | MED EXP (Any one person) |  |  |  | $ |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | PERSONAL & ADV INJURY |  |  |  | $ |\n|  | GEN'L AGGREGATE LIMIT APPLIES PER: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | GENERAL AGGREGATE |  |  |  | $ |\n|  |  | POLICY\u003Cbr>OTHER: |  |  |  | PRO\u003Cbr>JECT |  |  |  |  |  | LOC |  |  |  |  |  |  | PRODUCTS-COMP/OP AGG |  |  |  | $ |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | $ |\n|  | AUTOMOBILE LIABILITY |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | COMBINED SINGLE LIMIT (Ea accident) |  |  |  | $ |\n|  |  | ANY AUTO\u003Cbr>OWNED AUTOS ONLY HIRED AUTOS ONLY |  |  |  |  |  |  | SCHEDULED AUTOS NON-OWNED\u003Cbr>AUTOS ONLY |  |  |  |  |  |  |  |  |  | BODILY INJURY (Per person) |  |  |  | $ |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | BODILY INJURY (Per accident) |  |  |  | $ |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | PROPERTY DAMAGE (Per accident) |  |  |  | $ |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | $ |\n|  |  | UMBRELLA LIAB EXCESS LIAB |  |  |  |  |  |  |  |  | OCCUR\u003Cbr>CLAIMS-MADE |  |  |  |  |  |  |  | EACH OCCURRENCE |  |  |  | $ |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | AGGREGATE |  |  |  | $ |\n|  |  | DED |  |  | RETENTION $ |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | $ |\n|  | WORKERS COMPENSATION\u003Cbr>AND EMPLOYERS' LIABILITY\u003Cbr>ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED?\u003Cbr>(Mandatory in NH","cbCaibHaIAhFR67z","https://ap.wps.com/l/cbCaibHaIAhFR67z","pdf",53306,"English","# Certificate information\n## Issuance notice and limitations\n## Producer, insured, and insurer details\n## Coverage sections and policy schedule","[{\"question\":\"What does the certificate state about coverage and rights of the certificate holder?\",\"answer\":\"It states that issuance is for information only and does not confer rights or amend, extend, or alter the coverage provided by the policies. It also states the certificate does not constitute a contract between the insurer and the certificate holder.\"},{\"question\":\"Which details are included for the producer and insurers?\",\"answer\":\"The template includes producer identification, contact name, phone and fax, email address, insurer names, and NAIC number fields for multiple insurers.\"},{\"question\":\"How are policy period dates and limits organized in the form?\",\"answer\":\"Coverage entries list each policy type with policy number, effective date and expiration date, and the applicable limits such as each occurrence and aggregate limits, along with other relevant limit fields per section.\"}]","CERTIFICATE OF LIABILITY INSURANCE - Insurance Certificate Form | PDF"]