ACORD 23 Instructions

Section Name Field Name Field and/or Section Description
TITLE ACORD 23 (2009/12) Automobile Certificate of Insurance The title of the form. ACORD 23, Automobile Certificate of Insurance, is used to provide a coverage statement with respect to physical damage and/or liability insurance coverage to lessors or loss payers of leased vehicles, but only when the insurance policy covering the subject motor vehicle includes an "Additional Insured-Lessor" endorsement or a "loss payee endorsement" that contains a statement that the insurance company will send a notice to the lessor or loss payee in the event of policy termination. For all other situations requiring certification of property or liability insurance or evidence of property insurance, use ACORD 24, Certificate of Property Insurance; ACORD 25, Certificate of Liability Insurance; ACORD 27, Evidence of Personal Property Insurance, or ACORD 28, Evidence of Commercial Property Insurance.
IDENTIFICATION SECTION Date Enter date: The month/day/year on which the form is completed. (MM/DD/YYYY)
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 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.
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 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 Producer Customer ID Enter identifier: The customer's identification number assigned by the producer (e.g. agency or brokerage).
INSURER(S) AFFORDING COVERAGE Company 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.
INSURER(S) AFFORDING COVERAGE NAIC # Enter code: The identification code assigned to the insurer by the NAIC.
INSURER(S) AFFORDING COVERAGE Company 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.
INSURER(S) AFFORDING COVERAGE NAIC # Enter code: The identification code assigned to the insurer by the NAIC.
INSURER(S) AFFORDING COVERAGE Company 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.
INSURER(S) AFFORDING COVERAGE NAIC # Enter code: The identification code assigned to the insurer by the NAIC.
INSURER(S) AFFORDING COVERAGE Company 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.
INSURER(S) AFFORDING COVERAGE NAIC # Enter code: The identification code assigned to the insurer by the NAIC.
INSURER(S) AFFORDING COVERAGE Company 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.
INSURER(S) AFFORDING COVERAGE NAIC # Enter code: The identification code assigned to the insurer by the NAIC.
DESCRIPTION OF LEASED AUTO Year Enter year: The model year of the vehicle.
DESCRIPTION OF LEASED AUTO Make Enter text: The manufacturer of the vehicle (e.g. Ford, Chevy).
DESCRIPTION OF LEASED AUTO Model Enter text: The manufacturer's model name for the vehicle.
DESCRIPTION OF LEASED AUTO Body Type Enter code: The body type of the vehicle.
DESCRIPTION OF LEASED AUTO Vehicle Identification Number Enter identifier: The vehicle identification number (VIN) or serial number assigned by the manufacturer.
IDENTIFICATION SECTION Certificate Number Enter identifier: The insurer assigned number for the certificate.
COVERAGES Revision Number Enter number: The producer assigned revision number for the certificate.
COVERAGES Insr Ltr Enter code: The Company Letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the commercial vehicle policy.
COVERAGES Add'l Insrd 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 policy.
COVERAGES Auto Liability Check the box (if applicable): Indicates the vehicle has liability coverage.
COVERAGES 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.
COVERAGES Policy Effective Date Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence.
COVERAGES Policy Expiration Date Enter date: The date on which the terms and conditions of the policy will expire.
COVERAGES Limits 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).
COVERAGES 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).
COVERAGES 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).
COVERAGES 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).
COVERAGES Insr Ltr Enter code: The Company Letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the commercial vehicle policy.
COVERAGES Loss Payee Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as loss payee on the policy.
PHYSICAL DAMAGE Collision Loss Check the box (if applicable): Indicates the vehicle has collision coverage.
PHYSICAL DAMAGE Other Check the box (if applicable): Indicates the vehicle has a type of coverage not specifically listed.
PHYSICAL DAMAGE Other Description Enter text: The description of the other type of coverage on the vehicle.
COVERAGES 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.
COVERAGES Policy Effective Date Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence.
COVERAGES Policy Expiration Date Enter date: The date on which the terms and conditions of the policy will expire.
COVERAGES ACV Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle at the time of loss is the actual cash value or market value.
COVERAGES Other Limit Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle at the time of loss is other than those listed.
COVERAGES Other Limit Description Enter text: The valuation method used in determining the value of the vehicle at the time of loss.
COVERAGES Agreed Amount Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle at the time of loss is the agree amount.
COVERAGES Stated Amount Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle at the time of loss is the stated amount.
COVERAGES Limit Amount Enter limit: The limit associated with collision coverage.
COVERAGES Deductible Amount Enter deductible: The collision deductible amount.
COVERAGES Insr Ltr Enter code: The Company Letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the commercial vehicle policy.
COVERAGES Loss Payee Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as loss payee on the policy.
COVERAGES Comprehensive Check the box (if applicable): Indicates the vehicle has comprehensive or other than collision coverage. As used here, indicates the vehicle has comprehensive coverage.
COVERAGES Other Than Collision Check the box (if applicable): Indicates the vehicle has comprehensive or other than collision coverage. As used here, indicates the vehicle has other than collision coverage.
COVERAGES Other Check the box (if applicable): Indicates the vehicle has a type of coverage not specifically listed.
COVERAGES Other Description Enter text: The description of the other type of coverage on the vehicle.
COVERAGES 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.
COVERAGES Policy Effective Date Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence.
COVERAGES Policy Expiration Date Enter date: The date on which the terms and conditions of the policy will expire.
COVERAGES ACV Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle at the time of loss is the actual cash value or market value.
COVERAGES Other Limit Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle at the time of loss is other than those listed.
COVERAGES Other Limit Description Enter text: The valuation method used in determining the value of the vehicle at the time of loss.
COVERAGES Agreed Amount Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle at the time of loss is the agree amount.
COVERAGES Stated Amount Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle at the time of loss is the stated amount.
COVERAGES Limit Amount Enter limit: The limit associated with comprehensive coverage. In Texas this is the comprehensive limit only.
COVERAGES Deductible Amount Enter deductible: The comprehensive or other than collision deductible amount.
COVERAGES Insr Ltr Enter code: The Company Letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the commercial vehicle policy.
COVERAGES Loss Payee Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as loss payee on the policy.
COVERAGES Other Check the box (if applicable): Indicates the vehicle has a type of coverage not specifically listed.
COVERAGES Other Description Enter text: The description of the other type of coverage on the vehicle.
COVERAGES 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.
COVERAGES Policy Effective Date Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence.
COVERAGES Policy Expiration Date Enter date: The date on which the terms and conditions of the policy will expire.
COVERAGES ACV Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle at the time of loss is the actual cash value or market value.
COVERAGES Other Limit Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle at the time of loss is other than those listed.
COVERAGES Other Limit Description Enter text: The valuation method used in determining the value of the vehicle at the time of loss.
COVERAGES Agreed Amount Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle at the time of loss is the agree amount.
COVERAGES Stated Amount Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle at the time of loss is the stated amount.
COVERAGES Limit Amount Enter limit: The limit amount of the other coverage.
COVERAGES Deductible Amount Enter deductible: The deductible amount of the coverage.
COVERAGES Insr Ltr Enter code: The Company Letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the commercial vehicle policy.
COVERAGES Loss Payee Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as loss payee on the policy.
COVERAGES Other Check the box (if applicable): Indicates the vehicle has a type of coverage not specifically listed.
COVERAGES Other Description Enter text: The description of the other type of coverage on the vehicle.
COVERAGES 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.
COVERAGES Policy Effective Date Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence.
COVERAGES Policy Expiration Date Enter date: The date on which the terms and conditions of the policy will expire.
COVERAGES ACV Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle at the time of loss is the actual cash value or market value.
COVERAGES Other Limit Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle at the time of loss is other than those listed.
COVERAGES Other Limit Description Enter text: The valuation method used in determining the value of the vehicle at the time of loss.
COVERAGES Agreed Amount Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle at the time of loss is the agree amount.
COVERAGES Stated Amount Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle at the time of loss is the stated amount.
COVERAGES Limit Amount Enter limit: The limit amount of the other coverage.
COVERAGES Deductible Amount Enter deductible: The deductible amount of the coverage.
COVERAGES Remarks Enter text: The Certificate Of Liability Insurance general remarks.
ADDITIONAL INTEREST The additional interest(s) described below has been added to the policy(ies) listed herein by policy number(s). Check the box (if applicable): Indicates the additional insured has been added to the policy.
ADDITIONAL INTEREST A request has been submitted to add the additional interest(s) described below to the policy(ies) listed herein by policy number(s). Check the box (if applicable): Indicates a request to add the additional insured to the policy.
ADDITIONAL INTEREST Lender Check the box (if applicable): Indicates the additional interest type is a lender. As used here, this is a certificate holder.
ADDITIONAL INTEREST Lessor Check the box (if applicable): Indicates the additional interest type is a lessor. As used here, this is a certificate holder.
ADDITIONAL INTEREST Other Additional Interest Check the box (if applicable): Indicates the additional interest is not any of the types listed on the form. As used here, this is a certificate holder.
ADDITIONAL INTEREST Other Additional Interest Description Enter text: The description of the type of interest in the item.
ADDITIONAL INTEREST Name and Address of Additional Interest Enter text: The certificate holder's full name.
ADDITIONAL INTEREST Enter text: The certificate holder's mailing address line one.
ADDITIONAL INTEREST Enter text: The certificate holder's mailing address line two.
ADDITIONAL INTEREST Enter text: The certificate holder's mailing address city name.
ADDITIONAL INTEREST Enter code: The certificate holder's mailing address state or province code.
ADDITIONAL INTEREST Enter code: The certificate holder's mailing address postal code.
ADDITIONAL INTEREST Additional Insured Check the box (if applicable): Indicates the additional interest type is an additional insured.
ADDITIONAL INTEREST Lender's Loss Payee Check the box (if applicable): Indicates the additional interest type is a lenders loss payable.
ADDITIONAL INTEREST Loss Payee Check the box (if applicable): Indicates the additional interest type is a loss payee.
ADDITIONAL INTEREST Other Additional Interest Check the box (if applicable): Indicates the additional interest is not any of the types listed on the form.
ADDITIONAL INTEREST Other Additional Interest Description Enter text: The description of the type of interest in the item.
ADDITIONAL INTEREST Leased Vehicle (check box) Check the box (if applicable): Indicates the vehicle is leased.
ADDITIONAL INTEREST Financed Vehicle (check box) Check the box (if applicable): Indicates the vehicle is financed.
ADDITIONAL INTEREST Loan / Lease Number Enter identifier: The loan number, account number or other controlling number that the additional interest may have assigned the insured.
ADDITIONAL INTEREST Authorized Representative Sign here: Accommodates the signature of the authorized representative (e.g. producer, agent, broker, etc.) by all companies to issue Certificates. 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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