Sudbury Certificate Of Insurance Form PDF Details

If you're in the business of providing insurance products or services, having a well-crafted Sudbury Certificate Of Insurance Form is essential. This document must be presented to customers or clients as proof that their insurance has been purchased and is current. That's why understanding how to create an effective certificate of insurance form is vital for any business that deals with insurance products & services. In this blog post, we'll discuss everything you need to know about Sudbury Certificate Of Insurance Forms—from what they are and why they matter to tips on creating one properly. We'll also provide instructions on downloading and filling out your own copy so you can get started right away!

QuestionAnswer
Form NameSudbury Certificate Of Insurance Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesSpecial_Events_ Certificate certificate of insurance special event fillable form

Form Preview Example

Certificate of Insurance – Special Events

This is to certify that the insured, named below is insured as described below.

*** This form must be completed and signed by your insurer or insurance broker.***

Note: 1. Proof of liability insurance will be accepted on this form only (with no amendments). 2. If a facsimile has been transmitted, the original certificate must follow

Name of Insured:

Insured’s Address:

Telephone Number

(Area Code)

⏐

City

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Postal Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type of

 

Insurer’s Name

Policy Number

 

Effective Date

 

 

Expiry Date

 

Limits of Liability

 

 

 

Insurance

 

 

 

 

 

yr

mo

day

 

 

yr

mo

day

 

(Bodily Injury & Property

Deductible

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Damage-Inclusive)

 

 

 

Commercial

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

General Liability

 

 

 

 

 

 

⏐

⏐

 

 

⏐

 

⏐

 

$

$

 

 

Umbrella

 

 

 

 

 

 

⏐

⏐

 

 

⏐

 

⏐

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

$

 

 

Excess

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Commercial General Liability

 

Occurrence Basis, including Personal Injury, Property Damage, Broad Form Property Damage, Contractual Liability,

 

(including):

 

 

 

Non-Owned Automobile Liability, Work Performed on Behalf of the Named Insured by Sub-Contractors, Products –

 

 

 

 

 

Completed Operations, Contingent Employers Liability, Cross Liability Clause and Severability of Interest Clause.

 

DOES COVERAGE INCLUDE:

 

 

 

 

 

 

 

 

 

 

 

Limits ($)

 

 

•

Liquor Liability

NO

YES

$

•

Tenants Legal Liability

NO

 

YES

$

•

Injury to Participants

NO

 

YES

$

•

Fireworks

NO

 

YES

$

•

Watercraft

NO

 

YES

$

 

 

 

 

 

 

 

•

Sub-limits or Limitations

NO

 

YES

PLEASE INDICATE

The CITY OF GREATER SUDBURY has been added as an additional insured but only with respect to their interest in the operations of the Named Insured.

This is to certify that the policies of insurance as described above have been issued by the undersigned to the Insured named above and are in force at this time.

If cancelled or materially changed in any manner that would affect the CITY OF GREATER SUDBURY as outlined in coverage specified herein for any reason, so as to affect this certificate, thirty (30) days prior written notice, by registered mail or facsimile transmission will be given by the insurer(s) to:

CITY OF GREATER SUDBURY

ATTENTION: RISK MANAGEMENT / INSURANCE OFFICER

200 BRADY STREET, P.O. BOX 500, STATION A

SUDBURY, ON, P3A 5P3

FAX: (705) 673-0344

This certificate is executed and issued to the aforesaid City of Greater Sudbury, the day and date herein written below.

Name of Insurance Company or Broker (completing form)

Telephone Number with Area Code

 

⏐

 

 

Address

Fax Number with area code

 

 

⏐

 

 

Name of Authorized Representative or Official (Please Print)

Signature of Authorized Representative or Official

Date (Year, Month, Day)

 

 

⏐

⏐

Revised July 11/03

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Step 1: Click on the "Get Form" button above. It is going to open up our tool so that you could start completing your form.

Step 2: Once you access the PDF editor, there'll be the form prepared to be filled in. In addition to filling in various blanks, you may as well do other things with the file, including adding any text, editing the original textual content, inserting illustrations or photos, putting your signature on the form, and more.

This document will involve some specific details; to ensure accuracy, please be sure to heed the next suggestions:

1. Start completing your Sudbury Certificate Of Insurance Form with a selection of major blank fields. Note all of the important information and be sure nothing is forgotten!

Stage # 1 of completing Sudbury Certificate Of Insurance Form

2. Soon after the previous section is filled out, go to enter the applicable details in these: YES, YES, YES, YES, Injury to Participants, Sublimits or Limitations, Fireworks Watercraft The CITY, Please indicate, CITY OF GREATER SUDBURY, ATTENTION RISK MANAGEMENT, BRADY STREET PO BOX STATION A, SUDBURY ON PA P, FAX, This certificate is executed and, and Name of Insurance Company or.

How to complete Sudbury Certificate Of Insurance Form stage 2

3. Completing Telephone Number with Area Code, Name of Authorized Representative, Signature of Authorized, Date Year Month Day, and Revised July is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Stage no. 3 for filling out Sudbury Certificate Of Insurance Form

A lot of people generally make some errors when filling out Revised July in this area. Make sure you re-examine what you enter right here.

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