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It records certificate holder and producer information, policy period dates, insurer listings, coverage types such as commercial general liability, automobile liability, umbrella liability, and workers compensation, along with required limits and references. It includes disclaimers clarifying the certificate’s informational nature, conditions regarding additional insured status and subrogation, and an additional insured endorsement framework with cancellation notice and authorized representative section.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/certificate-of-liability-insurance-sample-package/385588/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/certificate-of-liability-insurance-sample-package/385588.png","ImageObject",442,249,{"name":88,"@type":89},"LangkahRina","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-13","2026-09-24",true,{"@type":98,"interactionType":99,"userInteractionCount":76},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What does the certificate state about its legal effect?","Question",{"text":108,"@type":109},"It is issued for information only and does not amend, extend, or alter coverage under the policies shown, nor does it constitute a contract with the certificate holder.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"How are additional insured requirements handled on the certificate?",{"text":113,"@type":109},"If the certificate holder is an additional insured, the policy(ies) must be endorsed; a statement on the certificate does not confer rights without those endorsements.",{"name":115,"@type":106,"acceptedAnswer":116},"What section is used for cancellation and who provides the notice?",{"text":117,"@type":109},"The certificate holder cancellation section states that if policies are cancelled before the expiration date, notice will be delivered according to the policy provisions, with an authorized representative signature.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},385588,1791352135,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":47,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":30,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":140},962090893776,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","| | 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 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\u003Cbr>SAMPLE CERTIFICATE OF GENERAL LIABILITY TO BE SUBMITTED BY A CBO NOT\u003Cbr>PARTICIPATING IN CIP |  | 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 : UNDERWRITER NAME |  |  | REQUIRED |\n| INSURED\u003Cbr>CBO NAME\u003Cbr>CBO ADDRESS\u003Cbr>CBO CITY, STATE, ZIP |  | INSURER B : |  |  |  |\n|  |  | INSURER C : |  |  |  |\n|  |  | INSURER D : |  |  |  |\n|  |  | INSURER E : |  |  |  |\n|  |  | INSURER F : |  |  |  |\n\nCOVERAGES CERTIFICATE NUMBER: REVISION NUMBER:  \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|  | X | COMMERCIAL GENERAL LIABILITY |  |  |  |  |  |  |  |  |  |  |  |  |  |  | REQUIRED | REQUIRED | EACH OCCURRENCE |  |  |  | $ $1,000,000 |\n|  | CLAIMS-MADE\u003Cbr> X \u003Cbr>OCCUR\u003Cbr>GEN'L AGGREGATE LIMIT APPLIES PER:\u003Cbr>|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | DAMAGE TO RENTED PREMISES (Ea occurrence) |  |  |  | $ |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | MED EXP (Any one person) |  |  |  | $ |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | PERSONAL & ADV INJURY |  |  |  | $ |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | GENERAL AGGREGATE |  |  |  | $ |\n|  | X | POLICY\u003Cbr>OTHER: |  |  |  | PRO\u003Cbr>JECT |  |  |  |  |  | LOC |  |  |  |  |  |  | PRODUCTS-COMP/OP AGG |  |  |  | $ |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | $ |\n|  | AUTOMOBILE LIABILITY |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | COMBINED SINGLE LIMIT (Ea accident) |  |  |  | $ |\n|  |  | ANY AUTO ALL OWNED\u003Cbr>AUTOS\u003Cbr>HIRED AUTOS |  |  |  |  |  |  | SCHEDULED AUTOS NON-OWNED AUTOS |  |  |  |  |  |  |  |  |  | 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|  |  |","cbCaiaLXtdYe5WdJ","https://ap.wps.com/l/cbCaiaLXtdYe5WdJ","pdf",912504,"English","# Coverage Certificate Details\n## Insurers, Limits, and Policy Period\n## Endorsements and Cancellation","[{\"question\":\"What does the certificate state about its legal effect?\",\"answer\":\"It is issued for information only and does not amend, extend, or alter coverage under the policies shown, nor does it constitute a contract with the certificate holder.\"},{\"question\":\"How are additional insured requirements handled on the certificate?\",\"answer\":\"If the certificate holder is an additional insured, the policy(ies) must be endorsed; a statement on the certificate does not confer rights without those endorsements.\"},{\"question\":\"What section is used for cancellation and who provides the notice?\",\"answer\":\"The certificate holder cancellation section states that if policies are cancelled before the expiration date, notice will be delivered according to the policy provisions, with an authorized representative signature.\"}]","Certificate of Liability Insurance - Sample Package | PDF",1790270126,6]