ACORD 20 Instructions


ACORD 20 (2009/05)

Section Name Field Name Field and/or Section Description
TITLE ACORD 20 (2009/05) Certificate of AviationLiability Insurance The title of the form. ACORD 20, Certificate of Aviation Liability Insurance, is “issued as a matter of information only, and confers no rights upon thecertificate holder. This certificate does not amend, extend, or alter the coverage afforded by policies”. The above information is included in the opening statement of the form. If the receiver of the form wants to verify that coverage exists on a policy and has no direct interest in the policy, use the certificate of insurance. However, if the receiver of the form does have a verifiable interest in the policy, such as an additional insured, the liability policy must be amended by endorsement, to provide the appropriate coverage for the interested party prior to issuing a certificate of insurance (since the certificate confers no rights upon the holder and does not amend the policy). Purpose of the Certificate of Insurance The purpose of the Certificate of Insurance has been the topic of frequent discussions throughout the industry. Attention centers around the true purpose of a certificate and the rights, if any, it conveys to a certificate holder.
In a 1974 court decision (United States Pipe & Foundry Co. v United States Fidelity & Guar. Co, 505 F. 2d 88 (5th Cir. 1974), the court ruled that a certificate is not a contract between the holder and theinsurer. It only provides information to an interested third party that insurance is in force at the time of issuance. The court also stated: “The provision regarding notification in the event of cancellation is a mere promise, unsupported by any consideration.” Although many companies provide notice of cancellation to certificate holders, they are not obliged to do so, since the holder is not a party to the contract.
TITLE The Certificate of Aviation Liability Insurance is used for most casualty situations in which the insured has requested certification to a third party of issued casualty coverages.
 

Section Name Field Name Field and/or Section Description
TITLE The ACORD Certificate should be issued only in compliance with company instructions. ACORD recommends that the Certificate NOT be used in the following situations: * To waive rights * To provide information to the owner of a leased motor vehicle or the lender about both liability and physical damage coverages applying to the vehicle (ACORD 23, Automobile Certificate of Insurance, should be used for this) * To quote wording from a contract * To attach to an endorsement * To quote any wording that amends a policy unless the policy itself has been amended
TITLE IMPORTANT Unlike ACORD 23, 24, 25, 27 and 28, certificates and evidence forms, ACORD 20 and 21 do not require filing since they deal exclusively with uncontrolled/unregulated inland marine insurance. Nevertheless, virtually every state will not allow any change in a certificate of insurance that would attempt to modify a policy unless the revised certificate is filed and approved as a policy form. In these states, this form can only be changed to reflect the terms and conditions of the policy on which it is reporting. Such change(s) must be approved in advance by the insurance carrier that issued such policy.
IDENTIFICATION SECTION Date (MM/DD/YYYY) Enter date: The month/day/year on which the form is completed. (MM/DD/YYYY)
IDENTIFICATION SECTION Agency 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.
 

Section Name Field Name Field and/or Section Description
IDENTIFICATION SECTION Enter code: The mailing address postal code of the producer/agency.
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 No. (A/C, No, Ext) 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).
INSURED Name & Mailing Address Enter text: The named insured(s) as it/they will appear on the policy declarations page.
INSURED Enter text: The named insured’s mailing address line one.
INSURED Enter text: The named insured’s mailing address line two.
INSURED Enter text: The named insured’s mailing address city name.
INSURED Enter code: The named insured’s mailing address state or province code.
INSURED Enter code: The named insured’s mailing address postal code.
INSURERS AFFORDING COVERAGE Company A Enter text: The insurer’s full legal company name(s) as found in thefile 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.
INSURERS AFFORDING COVERAGE Company A % Enter percentage: The percentage interest the insurer has in the policy.
INSURERS AFFORDING COVERAGE Company A NAIC # Enter code: The identification code assigned to the insurer by the NAIC.
INSURERS 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.
INSURERS AFFORDING COVERAGE Company B % Enter percentage: The percentage interest the insurer has in the policy.
INSURERS AFFORDING COVERAGE Company B NAIC # Enter code: The identification code assigned to the insurer by the NAIC.
INSURERS 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.
 

Section Name Field Name Field and/or Section Description
INSURERS AFFORDING COVERAGE Company C % Enter percentage: The percentage interest the insurer has in the policy.
INSURERS AFFORDING COVERAGE Company C NAIC # Enter code: The identification code assigned to the insurer by the NAIC.
INSURERS 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.
INSURERS AFFORDING COVERAGE Company D % Enter percentage: The percentage interest the insurer has in the policy.
INSURERS AFFORDING COVERAGE Company D NAIC # Enter code: The identification code assigned to the insurer by the NAIC.
INSURERS 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.
INSURERS AFFORDING COVERAGE Company E % Enter percentage: The percentage interest the insurer has in the policy.
INSURERS AFFORDING COVERAGE Company E NAIC # Enter code: The identification code assigned to the insurer by the NAIC.
INSURERS AFFORDING COVERAGE Company F 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.
INSURERS AFFORDING COVERAGE Company F % Enter percentage: The percentage interest the insurer has in the policy.
INSURERS AFFORDING COVERAGE Company F NAIC # Enter code: The identification code assigned to the insurer by the NAIC.
AIRPORT & FBO LIABILITY COVERAGES Certificate Number Enter number: The producer assigned number for the certificate.
AIRPORT & FBO LIABILITY COVERAGES Revision Number Enter number: The producer assigned revision number for the certificate.
AIRPORT & FBO LIABILITY COVERAGES Insurer Letter Enter code: The company letter of the insurer, as identified in the “Insurers Affording Coverage” form section, associated with the Airport & FBO Liability Policy.
AIRPORT & FBO LIABILITY 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. As used here, the Airport & FBO Liability policy number.
 

Section Name Field Name Field and/or Section Description
AIRPORT & FBO LIABILITY COVERAGES Effective Date Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. As used here, the Airport & FBO Liability policy effective date.
AIRPORT & FBO LIABILITY COVERAGES Expiration Date Enter date: The date on which the terms and conditions of the policy will expire. As used here, the Airport & FBO Liability policy expiration date.
AIRPORT & FBO LIABILITY COVERAGES Additional Insured? (Y / N) Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as an additional insured for any of the Airport & FBO policy coverages described in the certificate.
AIRPORT & FBO LIABILITY COVERAGES Premises Liability Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Premises Liability Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Premises Liability Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Premises Liability Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Premises Liability Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Premises Liability Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Premises Liability BI Ea Per Enter limit: The bodily injury each person limit amount for premises liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Premises Liability Ea Occ Enter limit: The each occurrence limit amount for premises liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Premises Liability PD Enter limit: The property damage limit amount for premises liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Premises Medical Payments Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Premises Medical Payments Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Premises Medical Payments Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Premises Medical Payments Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Premises Medical Payments Ea Per Enter limit: The each person limit amount for premises medical payments coverage.
 

Section Name Field Name Field and/or Section Description
AIRPORT & FBO LIABILITY COVERAGES Premises Medical Payments Ea Occ Enter limit: The each occurrence limit amount for premises medical payments coverage.
AIRPORT & FBO LIABILITY COVERAGES Products Liability Sale of Fuel & Oil Check the box (if applicable): Indicates the sale of fuel and oil option applies to the products liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Products Liability Extended Check the box (if applicable): Indicates the extended option applies to the products liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Products Liability Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Products Liability Option Description Enter text: The description of the option being requested. Examples: Sale of Used Aircraft, Sale of New Aircraft, Parts Installed, Parts Not Installed, Food and Beverage, Pilot Supplies.
AIRPORT & FBO LIABILITY COVERAGES Products Liability BI Ea Per Enter limit: The bodily injury each person limit amount for products liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Products Liability Ea Occ Enter limit: The each occurrence limit amount for products liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Products Liability Aggr Enter limit: The aggregate limit amount for products liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Completed Operations Extended Check the box (if applicable): Indicates the extended option applies to the completed operations liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Completed Operations Liability Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Completed Operations Liability Option Description Enter text: The description of the option being requested. Examples: Sale of Fuel and Oil, Parts Not Installed, Sale of New Aircraft, Sale of Used Aircraft, Restaurant Liability, Repair and Services.
AIRPORT & FBO LIABILITY COVERAGES Completed Operations Liability Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Completed Operations Liability Option Description Enter text: The description of the option being requested. Examples: Sale of Fuel and Oil, Parts Not Installed, Sale of New Aircraft, Sale of Used Aircraft, Restaurant Liability, Repair and Services.
AIRPORT & FBO LIABILITY COVERAGES Completed Operations Liability BI Ea Per Enter limit: The bodily injury each person limit amount for completed operations liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Completed Operations Liability Ea Occ Enter limit: The each occurrence limit amount for completed operations liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Completed Operations Liability Aggr Enter limit: The aggregate limit amount for completed operations liability coverage.
 

Section Name Field Name Field and/or Section Description
AIRPORT & FBO LIABILITY COVERAGES Hangarkeepers Legal Liability Including Taxi Check the box (if applicable): Indicates the including taxi option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Hangarkeepers Legal Liability In Flight Check the box (if applicable): Indicates the in flight option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Hangarkeepers Legal Liability Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Hangarkeepers Legal Liability Option Description Enter text: The description of the option being requested. Example: Ground Only.
AIRPORT & FBO LIABILITY COVERAGES Hangarkeepers Legal Liability Ea Aircraft Enter limit: The each aircraft limit amount for hangarkeepers legal liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Hangarkeepers Legal Liability Ea Occ Enter limit: The each occurrence limit amount for hangarkeepers legal liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Fire Legal Liability Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Fire Legal Liability Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Fire Legal Liability Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Fire Legal Liability Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Fire Legal Liability Any One Fire Enter limit: The any one fire limit amount for fire legal liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Personal Injury Liability Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Personal Injury Liability Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Personal Injury Liability Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Personal Injury Liability Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Personal Injury Liability Ea Occ Enter limit: The each occurrence limit amount for personal injury liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Personal Injury Liability Aggr Enter limit: The aggregate limit amount for personal injury liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Advertising Liability Option Checkbox Check the box (if applicable): The description of the option being requested.
 

Section Name Field Name Field and/or Section Description
AIRPORT & FBO LIABILITY COVERAGES Advertising Liability Option Description Enter text: The any one fire limit amount for fire legal liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Advertising Liability Option Checkbox Check the box (if applicable): The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Advertising Liability Option Description Enter text: The any one fire limit amount for fire legal liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Advertising Liability Ea Occ Enter limit: The each occurrence limit amount for advertising liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Advertising Liability Aggr Enter limit: The aggregate limit amount for advertising liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Contractual Liability Included Check the box (if applicable): Indicates contractual liability coverage is included in the policy.
AIRPORT & FBO LIABILITY COVERAGES Contractual Liability Excluded Check the box (if applicable): Indicates contractual liability coverage is excluded from the policy.
AIRPORT & FBO LIABILITY COVERAGES Coverage Code Enter code: The code for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Coverage Description Enter text: The description of other coverage (not the limit) on the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s)
AIRPORT & FBO LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRPORT & FBO LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
 

Section Name Field Name Field and/or Section Description
AIRPORT & FBO LIABILITY COVERAGES Coverage Code Enter code: The code for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Coverage Description Enter text: The description of other coverage (not the limit) on the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s)
AIRPORT & FBO LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRPORT & FBO LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRPORT & FBO LIABILITY COVERAGES Coverage Code Enter code: The code for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Coverage Description Enter text: The description of other coverage (not the limit) on the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s)
AIRPORT & FBO LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
 

Section Name Field Name Field and/or Section Description
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRPORT & FBO LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRPORT & FBO LIABILITY COVERAGES Coverage Code Enter code: The code for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Coverage Description Enter text: The description of other coverage (not the limit) on the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s)
AIRPORT & FBO LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRPORT & FBO LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRPORT & FBO LIABILITY COVERAGES Coverage Code Enter code: The code for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Coverage Description Enter text: The description of other coverage (not the limit) on the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s)
AIRPORT & FBO LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
 

Section Name Field Name Field and/or Section Description
AIRPORT & FBO LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRPORT & FBO LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRPORT & FBO LIABILITY COVERAGES Coverage Code Enter code: The code for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Coverage Description Enter text: The description of other coverage (not the limit) on the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s)
AIRPORT & FBO LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRPORT & FBO LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRPORT & FBO LIABILITY COVERAGES Coverage Code Enter code: The code for the coverage.
 

Section Name Field Name Field and/or Section Description
AIRPORT & FBO LIABILITY COVERAGES Coverage Description Enter text: The description of other coverage (not the limit) on the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s)
AIRPORT & FBO LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRPORT & FBO LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRPORT & FBO LIABILITY COVERAGES Coverage Code Enter code: The code for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Coverage Description Enter text: The description of other coverage (not the limit) on the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s)
AIRPORT & FBO LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
 

Section Name Field Name Field and/or Section Description
AIRPORT & FBO LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRPORT & FBO LIABILITY COVERAGES Coverage Code Enter code: The code for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Coverage Description Enter text: The description of other coverage (not the limit) on the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s)
AIRPORT & FBO LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRPORT & FBO LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
DESCRIPTION OF OPERATIONS / REMARKS (Attach ACORD 101, Additional Remarks Schedule if more space is required) Description of Operations Enter text: The Certificate Of Aviation Liability Insurance general remarks including the description of operations. Attach ACORD 101, Additional Remarks Schedule, if more space is required.
CERTIFICATE HOLDER Certificate Holder Name & Address Enter text: The certificate holder’s full name.
CERTIFICATE HOLDER Enter text: The certificate holder’s mailing address line one.
CERTIFICATE HOLDER Enter text: The certificate holder’s mailing address line two.
CERTIFICATE HOLDER Enter text: The certificate holder’s mailing address city name.
 

Section Name Field Name Field and/or Section Description
CERTIFICATE HOLDER Enter code: The certificate holder’s mailing address state or province code.
CERTIFICATE HOLDER Enter code: The certificate holder’s mailing address postal code.
CANCELLATION Days to Cancel Enter number: The number of days in which the insurer will endeavor to mail a written cancellation notice. This amount is subject to approval by the insurer(s).
CANCELLATION 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. As used here, the authorized representative by all companies to issue Certificates.
IDENTIFICATION SECTION Producer Customer ID Enter identifier: The customer’s identification number assigned by the producer (e.g. agency or brokerage).
PRIVATE HANGAR LIABILITY COVERAGES Insurer Letter Enter code: The company letter of the insurer, as identified in the “Insurers Affording Coverage” form section, associated with the Private Hangar Liability Policy.
PRIVATE HANGAR LIABILITY 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. As used here, the Private Hangar Liability policy number.
PRIVATE HANGAR LIABILITY COVERAGES Effective Date Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. As used here, the Private Hangar Liability policy effective date.
PRIVATE HANGAR LIABILITY COVERAGES Expiration Date Enter date: The date on which the terms and conditions of the policy will expire. As used here, the Private Hangar Liability policy expiration date.
PRIVATE HANGAR LIABILITY COVERAGES Additional Insured? (Y / N) Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as an additional insured for any of the Private Hangar Liability policy coverages described in the certificate.
PRIVATE HANGAR LIABILITY COVERAGES Hangarkeepers Legal Liability Including Taxi Check the box (if applicable): Indicates the including taxi option applies to the coverage.
PRIVATE HANGAR LIABILITY COVERAGES Hangarkeepers Legal Liability In Flight Check the box (if applicable): Indicates the in flight option applies to the coverage.
PRIVATE HANGAR LIABILITY COVERAGES Hangarkeepers Legal Liability Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
PRIVATE HANGAR LIABILITY COVERAGES Hangarkeepers Legal Liability Option Description Enter text: The description of the option being requested. Example: Ground Only.
PRIVATE HANGAR LIABILITY COVERAGES Hangarkeepers Legal Liability Ea Aircraft Enter limit: The each aircraft limit amount for hangarkeepers legal liability coverage.
PRIVATE HANGAR LIABILITY COVERAGES Hangarkeepers Legal Liability Ea Occ Enter limit: The each occurrence limit amount for hangarkeepers legal liability coverage.
 

Section Name Field Name Field and/or Section Description
PRIVATE HANGAR LIABILITY COVERAGES Coverage Code Enter code: The code for the coverage.
PRIVATE HANGAR LIABILITY COVERAGES Coverage Description Enter text: The description of other coverage (not the limit) on the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s)
PRIVATE HANGAR LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
PRIVATE HANGAR LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
PRIVATE HANGAR LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
PRIVATE HANGAR LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
PRIVATE HANGAR LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
PRIVATE HANGAR LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
PRIVATE HANGAR LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
PRIVATE HANGAR LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
PRIVATE HANGAR LIABILITY COVERAGES Coverage Code Enter code: The code for the coverage.
PRIVATE HANGAR LIABILITY COVERAGES Coverage Description Enter text: The description of other coverage (not the limit) on the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s)
PRIVATE HANGAR LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
PRIVATE HANGAR LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
PRIVATE HANGAR LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
PRIVATE HANGAR LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
PRIVATE HANGAR LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
 

Section Name Field Name Field and/or Section Description
PRIVATE HANGAR LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
PRIVATE HANGAR LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
PRIVATE HANGAR LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AVIATION PRODUCTS LIABILITY COVERAGES Insurer Letter Enter code: The company letter of the insurer, as identified in the “Insurers Affording Coverage” form section, associated with the Products Liability policy.
AVIATION PRODUCTS LIABILITY 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. As used here, the Aviation Products Liability policy number.
AVIATION PRODUCTS LIABILITY COVERAGES Effective Date Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. As used here, the Aviation Products Liability policy effective date.
AVIATION PRODUCTS LIABILITY COVERAGES Expiration Date Enter date: The date on which the terms and conditions of the policy will expire. As used here, the Aviation Products Liability policy expiration date.
AVIATION PRODUCTS LIABILITY COVERAGES Additional Insured? (Y / N) Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as an additional insured for any of the Products Liability policy coverages described in the certificate.
AVIATION PRODUCTS LIABILITY COVERAGES Products Liability Incl Comp Ops Check the box (if applicable): Indicates completed operations are included in the products liability coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Products Liability Excl Comp Ops Check the box (if applicable): Indicates completed operations are excluded from the products liability coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Products Liability Incl Spacecraft Check the box (if applicable): Indicates spacecraft are included in the products liability coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Products Liability Excl Spacecraft Check the box (if applicable): Indicates spacecraft are excluded from the products liability coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Products Liability Ea Occ Enter limit: The each occurrence limit for products liability coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Products Liability Aggr Enter limit: The aggregate limit for products liability coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Grounding Liability Ea Occ Enter limit: The each occurrence limit amount for grounding liability coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Grounding Liability Aggr Enter limit: The aggregate limit amount for grounding liability coverage.
 

Section Name Field Name Field and/or Section Description
AVIATION PRODUCTS LIABILITY COVERAGES Foreign Military Aircraft Products Included Check the box (if applicable): Indicates foreign military aircraft products coverage is included in the policy.
AVIATION PRODUCTS LIABILITY COVERAGES Coverage Code Enter code: The code for the coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Coverage Description Enter text: The description of other coverage (not the limit) on the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s)
AVIATION PRODUCTS LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AVIATION PRODUCTS LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AVIATION PRODUCTS LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AVIATION PRODUCTS LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AVIATION PRODUCTS LIABILITY COVERAGES Coverage Code Enter code: The code for the coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Coverage Description Enter text: The description of other coverage (not the limit) on the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s)
AVIATION PRODUCTS LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AVIATION PRODUCTS LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
 

Section Name Field Name Field and/or Section Description
AVIATION PRODUCTS LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AVIATION PRODUCTS LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Line of Business Enter text: The description of the line of business classification.
OTHER COVERAGES Insurer Letter Enter code: The company letter of the insurer, as identified in the “Insurers Affording Coverage” form section, associated with the policy.
OTHER 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.
OTHER COVERAGES Effective Date Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence.
OTHER COVERAGES Expiration Date Enter date: The date on which the terms and conditions of the policy will expire.
OTHER COVERAGES Additional Insured? (Y / N) Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as an additional insured for any of the policy coverages described in this section of the certificate.
OTHER COVERAGES Coverage Code Enter code: The code for the coverage.
OTHER COVERAGES Coverage Description Enter text: The description of other coverage (not the limit) on the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s)
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
 

Section Name Field Name Field and/or Section Description
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Coverage Code Enter code: The code for the coverage.
OTHER COVERAGES Coverage Description Enter text: The description of other coverage (not the limit) on the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s)
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Coverage Code Enter code: The code for the coverage.
OTHER COVERAGES Coverage Description Enter text: The description of other coverage (not the limit) on the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s)
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.

 

Section Name Field Name Field and/or Section Description
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Coverage Code Enter code: The code for the coverage.
OTHER COVERAGES Coverage Description Enter text: The description of other coverage (not the limit) on the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s)
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Coverage Code Enter code: The code for the coverage.
OTHER COVERAGES Coverage Description Enter text: The description of other coverage (not the limit) on the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s)
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
 

Section Name Field Name Field and/or Section Description
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Coverage Code Enter code: The code for the coverage.
OTHER COVERAGES Coverage Description Enter text: The description of other coverage (not the limit) on the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s)
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Line of Business Enter text: The description of the line of business classification.
OTHER COVERAGES Insurer Letter Enter code: The company letter of the insurer, as identified in the “Insurers Affording Coverage” form section, associated with the policy.
 

Section Name Field Name Field and/or Section Description
OTHER 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.
OTHER COVERAGES Effective Date Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence.
OTHER COVERAGES Expiration Date Enter date: The date on which the terms and conditions of the policy will expire.
OTHER COVERAGES Additional Insured? (Y / N) Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as an additional insured for any of the policy coverages described in this section of the certificate.
OTHER COVERAGES Coverage Code Enter code: The code for the coverage.
OTHER COVERAGES Coverage Description Enter text: The description of other coverage (not the limit) on the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s)
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Coverage Code Enter code: The code for the coverage.
OTHER COVERAGES Coverage Description Enter text: The description of other coverage (not the limit) on the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s)
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
 

Section Name Field Name Field and/or Section Description
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Coverage Code Enter code: The code for the coverage.
OTHER COVERAGES Coverage Description Enter text: The description of other coverage (not the limit) on the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s)
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Coverage Code Enter code: The code for the coverage.
 

Section Name Field Name Field and/or Section Description
OTHER COVERAGES Coverage Description Enter text: The description of other coverage (not the limit) on the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s)
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Coverage Code Enter code: The code for the coverage.
OTHER COVERAGES Coverage Description Enter text: The description of other coverage (not the limit) on the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s)
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
Section Name Field Name Field and/or Section Description
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Coverage Code Enter code: The code for the coverage.
OTHER COVERAGES Coverage Description Enter text: The description of other coverage (not the limit) on the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s)
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
Edition Date The edition identifier of the form including the form number and edition (the date is typically formatted YYYY/MM).