ACORD 22 Instructions


ACORD 22 (2009/12) rev. 01-29-2010

Section Name Field Name Field and/or Section Description
TITLE ACORD 22 (2009/12) Intermodal Interchange Certificate of Insurance The title of the form. ACORD 22, Intermodal Interchange Certificate of Insurance, is used to provide a coverage statement to the Intermodal Association of North America (IANA) when coverage being provided includes the Truckers Uniform Intermodal Interchange Endorsement (Form UIIE-1 or CA-23-17 equivalent). IMPORTANT Kentucky, Minnesota, North Carolina and Wisconsin require the filing of certificate of insurance forms. ACORD has filed all of its certificates in these states. In these states, the text of ACORD’s certificates cannot be modified, unless the modified form is filed for approval by the respective state Department of Insurance. Additionally, virtually every other 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.
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 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.
 

Section Name Field Name Field and/or Section Description
IDENTIFICATION SECTION Producer Customer ID Enter identifier: The customer’s identification number assigned by the producer (e.g. agency or brokerage).
IDENTIFICATION SECTION Insured Name and Address 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.
INSURERS AFFORDING COVERAGE Insurer 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.
NAIC # NAIC # Enter code: The identification code assigned to the insurer by the NAIC.
BEST RATING Best Rating Enter code: The AM Best rating code for the insurer.
INSURERS AFFORDING COVERAGE Insurer 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.
NAIC # NAIC # Enter code: The identification code assigned to the insurer by the NAIC.
BEST RATING Best Rating Enter code: The AM Best rating code for the insurer.
INSURERS AFFORDING COVERAGE Insurer 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.
NAIC # NAIC # Enter code: The identification code assigned to the insurer by the NAIC.
BEST RATING Best Rating Enter code: The AM Best rating code for the insurer.
INSURERS AFFORDING COVERAGE Insurer 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.
NAIC # NAIC # Enter code: The identification code assigned to the insurer by the NAIC.
BEST RATING Best Rating Enter code: The AM Best rating code for the insurer.
 

Section Name Field Name Field and/or Section Description
INSURERS AFFORDING COVERAGE Insurer 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.
NAIC # NAIC # Enter code: The identification code assigned to the insurer by the NAIC.
BEST RATING Best Rating Enter code: The AM Best rating code for the insurer.
COVERAGE INFORMATION Insr LtrGeneral Liability Enter code: The Company Letter of the insurer, as identified in the “Insurer(s) Affording Coverage” form section, associated with the commercial general liability policy.
COVERAGE INFORMATION Addl Insr General Liability Check the box (if applicable): Indicates the certificate holderhas been named as an additional insured for any of the commercial general liability policy coverages described in the certificate.
COVERAGE INFORMATION Commercial General Liability Check the box (if applicable): Indicates the claims made or occurrence option applies for the general liability policy.
COVERAGE INFORMATION Claims-Made Check the box (if applicable): Indicates the “claims made” option applies on the general liability policy.
COVERAGE INFORMATION Occur Check the box (if applicable): Indicates the general liability policy, occurrence basis applies.
COVERAGE INFORMATION Other General Liability Checkbox Check the box (if applicable): Indicates other coverage not found on the form exists for the general liability policy.
COVERAGE INFORMATION Other General Liability Description Enter text: The description of other coverage (not the limit) on the general liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION Other General Liability Checkbox Check the box (if applicable): Indicates other coverage not found on the form exists for the general liability policy.
COVERAGE INFORMATION Other General Liability Description Enter text: The description of other coverage (not the limit) on the general liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION General Aggregate Limit Applies Per: – Policy Check the box (if applicable): Indicates the general liability policy, general aggregate limit applies per policy.
COVERAGE INFORMATION General Aggregate Limit Applies Per: – Other Check the box (if applicable): Indicates the general liability policy, general aggregate limit applies to code is other than those listed.
COVERAGE INFORMATION General Aggregate Limit Applies Per: – Other Description Enter code: The limit applies to code for the general liability policy, general aggregate limit.
COVERAGE INFORMATION 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.
 

Section Name Field Name Field and/or Section Description
COVERAGE INFORMATION Policy Effective Date (MM/DD/YYYY) Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence.
COVERAGE INFORMATION Policy Expiration Date (MM/DD/YYYY) Enter date: The date on which the terms and conditions of the policy will expire.
COVERAGE INFORMATION Each Occurrence Enter limit: The general liability, each occurrence limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION Damage to Rented Premises Enter limit: The general liability, damage to rented premises each occurrence limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION Med Exp Enter limit: The general liability, medical expense each person limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION Personal & Adv Injury Enter limit: The general liability, personal and advertising injury limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION General Aggregate Enter limit: The general liability, general aggregate limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION Products – Comp/Op Agg Enter limit: The general liability, products and completed operations aggregate limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION Other Limit Description Enter limit: The general liability, other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION Other Limit Enter text: The description of other coverage (not the limit). Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION 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.
COVERAGE INFORMATION Addl Insr Check the box (if applicable): Indicates the certificate holder has been named as an additional insured for any of the vehicle policy coverages described in the certificate.
COVERAGE INFORMATION Any Auto Check the box (if applicable): Indicates the commercial vehicle policy covers any auto.
COVERAGE INFORMATION All Owned Autos Check the box (if applicable): Indicates the commercial vehicle policy covers all owned autos.
 

Section Name Field Name Field and/or Section Description
COVERAGE INFORMATION Scheduled Autos Check the box (if applicable): Indicates the vehicle policy covers scheduled autos.
COVERAGE INFORMATION Hired Autos Check the box (if applicable): Indicates the vehicle policy covers hired autos.
COVERAGE INFORMATION Non-Owned Autos Check the box (if applicable): Indicates the vehicle policy covers non-owned autos.
COVERAGE INFORMATION Other Automobile Liability Check the box (if applicable): Indicates other coverage not found on the form exists for the vehicle policy.
COVERAGE INFORMATION Other Automobile Liability – Field Enter text: The description of other coverage (not the limit) on the vehicle policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION 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.
COVERAGE INFORMATION Policy Effective Date (MM/DD/YYYY) Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence.
COVERAGE INFORMATION Policy Expiration Date (MM/DD/YYYY) Enter date: The date on which the terms and conditions of the policy will expire.
COVERAGE INFORMATION 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).
COVERAGE INFORMATION 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).
COVERAGE INFORMATION 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).
COVERAGE INFORMATION 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).
COVERAGE INFORMATION Insr Ltr Enter code: The Company Letter of the insurer, as identified in the “Insurer(s) Affording Coverage” form section, associated with the motor truck cargo policy.
COVERAGE INFORMATION Addl Insr Check the box (if applicable): Indicates the certificate holder has been named as an additional insured for any of the motor truck cargo policy coverages described in the certificate.
 

Section Name Field Name Field and/or Section Description
COVERAGE INFORMATION Per Vehicle Ded Enter deductible: The deductible amount for the coverage.
COVERAGE INFORMATION 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.
COVERAGE INFORMATION Policy Effective Date (MM/DD/YYYY) Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence.
COVERAGE INFORMATION Policy Expiration Date (MM/DD/YYYY) Enter date: The date on which the terms and conditions of the policy will expire.
COVERAGE INFORMATION Limits Enter limit: The cargo limit amount.
COVERAGE INFORMATION Insr Ltr Enter code: The Company Letter of the insurer, as identified in the “Insurer(s) Affording Coverage” form section, associated with the trailer interchange portion of the vehicle policy.
COVERAGE INFORMATION Addl Insr Check the box (if applicable): Indicates the certificate holder has been named as an additional insured for any of the trailer interchange coverages described in the certificate.
COVERAGE INFORMATION Per Trailer Ded Enter deductible: The deductible amount applicable to trailer interchange collision coverage.
COVERAGE INFORMATION 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.
COVERAGE INFORMATION Policy Effective Date (MM/DD/YYYY) Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence.
COVERAGE INFORMATION Policy Expiration Date (MM/DD/YYYY) Enter date: The date on which the terms and conditions of the policy will expire.
COVERAGE INFORMATION Limit Per Trailer Enter limit: The per trailer limit amount for trailer interchange collision coverage.
COVERAGE INFORMATION Insr Ltr Enter code: The Company Letter of the insurer, as identified in the “Insurer(s) Affording Coverage” form section, associated with the commercial excess umbrella liability policy.
COVERAGE INFORMATION Addl Insr Check the box (if applicable): Indicates the certificate holder has been named as an additional insured for any of the commercial excess umbrella liability policy coverages described in the certificate.
COVERAGE INFORMATION Umbrella Liab Check the box (if applicable): Indicates the type of policy is umbrella.
 

Section Name Field Name Field and/or Section Description
COVERAGE INFORMATION Excess Liab Check the box (if applicable): Indicates the type of policy is excess.
COVERAGE INFORMATION Occur Check the box (if applicable): Indicates “coverage trigger” is on an occurrence basis on an excess or umbrella liability policy.
COVERAGE INFORMATION Claims-Made Check the box (if applicable): Indicates the “coverage trigger” is on a claims-made basis on an excess or umbrella liability policy.
COVERAGE INFORMATION Deductible Check the box (if applicable): This indicates whether a deductible or retention amount applies to the excess or umbrella liability policy.
COVERAGE INFORMATION Retention Check the box (if applicable): Indicates the excess or umbrella liability policy has an applicable deductible or retention amount.
COVERAGE INFORMATION Amount $ Enter deductible: The excess or umbrella liability deductible or retention amount.
COVERAGE INFORMATION 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.
COVERAGE INFORMATION Policy Effective Date (MM/DD/YYYY) Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence.
COVERAGE INFORMATION Policy Expiration Date (MM/DD/YYYY) Enter date: The date on which the terms and conditions of the policy will expire.
COVERAGE INFORMATION Each Occurrence Enter limit: The excess umbrella liability limit each occurrence limit.
COVERAGE INFORMATION Aggregate Enter limit: The excess/umbrella liability aggregate limit should be listed as whole dollar amount, as found on the policy declarations page. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION Other Limit Enter text: The description of other coverage (not the limit) on the excess umbrella liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION Other Limit Amount Enter limit: The excess umbrella liability limit other coverage limit. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION Other Limit Enter text: The description of other coverage (not the limit) on the excess umbrella liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
 

Section Name Field Name Field and/or Section Description
COVERAGE INFORMATION Other Limit Amount Enter limit: The excess umbrella liability limit other coverage limit. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION Insr Ltr Enter code: The Company Letter of the insurer, as identified in the “Insurer(s) Affording Coverage” form section, associated with the commercial workers compensation and employers liability policy.
COVERAGE INFORMATION Type of Insurance – Workers Compensation and Employers’ Liability Enter Y for a “Yes” response. Input N for “No” response. Indicates whether the workers compensation and employers liability policy excludes any proprietor, partner, executive officer, or member.
COVERAGE INFORMATION 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.
COVERAGE INFORMATION Policy Effective Date (MM/DD/YYYY) Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence.
COVERAGE INFORMATION Policy Expiration Date (MM/DD/YYYY) Enter date: The date on which the terms and conditions of the policy will expire.
COVERAGE INFORMATION WC Statutory Limits Check the box (if applicable): Indicates that workers compensation statutory limits apply.
COVERAGE INFORMATION Other Check the box (if applicable): Indicates that additional coverage above the workers compensation statutory limits applies (permitted in some states). Describe the additional coverage in the Special Provisions section.
COVERAGE INFORMATION Field Box Enter text: The description of other coverage (not the limit) on the workers compensation and employers liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION E.L. Each Accident Enter limit: The workers compensation and employers liability policy, employers liability each accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION E.L. Disease – Ea Employee Enter limit: The workers compensation and employers liability policy, employers liability disease each employee limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION E.L. Disease – Policy Limit Enter limit: The workers compensation and employers liability policy, employers liability disease policy limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION Insr Ltr Enter code: The Company Letter of the insurer, as identified in the “Insurer(s) Affording Coverage” form section, associated with the other policy.
Section Name Field Name Field and/or Section Description
COVERAGE INFORMATION Type of Insurance – Other Enter text: The description of the other policy not listed on the form.
COVERAGE INFORMATION 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.
COVERAGE INFORMATION Policy Effective Date (MM/DD/YYYY) Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence.
COVERAGE INFORMATION Policy Expiration Date (MM/DD/YYYY) Enter date: The date on which the terms and conditions of the policy will expire.
COVERAGE INFORMATION Limits Enter limit: The other policy, coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
COVERAGE INFORMATION The Truckers Uniform Intermodal Interchange Endorsement Check the box (if applicable): Indicates the Truckers Uniform Intermodal Interchange Endorsement (Form UIIE-1 or CA 23-17 equivalent) is part of the auto policy(ies). The attached list of providers are additional insureds in regards to the auto liability. Those providers with (*) are additional insureds on the general liability and those with (**) are additional insureds on trailer interchange coverage.
COVERAGE INFORMATION Description of Operations / Locations / Vehicles / Exclusions Added by Endorsement / Special Provisions Enter text: The Certificate Of Liability Insurance general remarks.
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.
Edition Date The edition identifier of the form including the form number and edition (the date is typically formatted YYYY/MM).