| Section Name | Field Name | Field and/or Section Description |
| TITLE ACORD 30 (2010/12) | Certificate of Garage Insurance | The title of the form. ACORD 30, Certificate of Garage Liability Insurance, is “issued as a matter of information only, and confers no rights upon the certificate holder. This certificate does not affirmatively or negatively amend, extend, or alter the coverage afforded by policies.” The above information is included in the opening statement of the form. If the receiver of the form wants toverify that garage liability coverage exists on a policy and has no direct interest in the policy, use the garage liability certificate of insurance. However, if the receiver of the form does have a verifiable interest in the policy, such as an additional insured, the garage 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). ACORD 30 was designed to collect policy limit information based on the ISO commercial lines program. |
| TITLE | IMPORTANT Iowa, Kansas, Kentucky, Minnesota, Missouri, North Carolina, North Dakota, Oklahoma, Utah 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. 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 | 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. |
| Section Name | Field Name | Field and/or Section Description |
| IDENTIFICATION SECTION | Address Line 1 | Enter text: The mailing address line one of the producer/agency. |
| IDENTIFICATION SECTION | Address Line 2 | Enter text: The mailing address line two of the producer/agency. |
| IDENTIFICATION SECTION | City | Enter text: The mailing address city name of the producer/agency. |
| IDENTIFICATION SECTION | State | Enter code: The mailing address state or province code of the producer/agency. |
| IDENTIFICATION SECTION | Zip | 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 | 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 | Email Address | Enter text: The producer’s contact person e-mail address. |
| IDENTIFICATION SECTION | Insured | Enter text: The named insured(s) as it/they will appear on the policy declarations page. |
| IDENTIFICATION SECTION | Address Line 1 | Enter text: The named insured’s mailing address line one. |
| IDENTIFICATION SECTION | Address Line 2 | Enter text: The named insured’s mailing address line two. |
| IDENTIFICATION SECTION | City | Enter text: The named insured’s mailing address city name. |
| IDENTIFICATION SECTION | State | Enter code: The named insured’s mailing address state or province code. |
| IDENTIFICATION SECTION | Zip | Enter code: The named insured’s mailing address postal code. |
| IDENTIFICATION SECTION | 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. |
| IDENTIFICATION SECTION | NAIC # | Enter code: The identification code assigned to the insurer by the NAIC. |
| Section Name | Field Name | Field and/or Section Description |
| IDENTIFICATION SECTION | 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. |
| IDENTIFICATION SECTION | NAIC # | Enter code: The identification code assigned to the insurer by the NAIC. |
| IDENTIFICATION SECTION | 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. |
| IDENTIFICATION SECTION | NAIC # | Enter code: The identification code assigned to the insurer by the NAIC. |
| IDENTIFICATION SECTION | 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. |
| IDENTIFICATION SECTION | NAIC # | Enter code: The identification code assigned to the insurer by the NAIC. |
| IDENTIFICATION SECTION | 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. |
| IDENTIFICATION SECTION | NAIC # | Enter code: The identification code assigned to the insurer by the NAIC. |
| IDENTIFICATION SECTION | Insurer 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. |
| IDENTIFICATION SECTION | NAIC # | Enter code: The identification code assigned to the insurer by the NAIC. |
| COVERAGES | Prod/Customer ID | Enter identifier: The customer’s identification number assigned by the producer (e.g. agency or brokerage). |
| COVERAGES | Certificate # | Enter identifier: The producer assigned number for the certificate. |
| COVERAGES | Revision # | Enter number: The producer assigned revision number for the certificate. |
| COVERAGES | Insurer Letter | Enter code: The Company Letter of the insurer, as identified in the “Insurer(s) Affording Coverage” form section, associated with the commercial garage liability policy. |
| COVERAGES | All Owned Autos | Check the box (if applicable): Indicates the all owned autos option applies for the garage liability policy. |
| COVERAGES | Hired Autos Only | Check the box (if applicable): Indicates the hired autos only option applies for the garage liability policy. |
| Section Name | Field Name | Field and/or Section Description |
| COVERAGES | Non-Owned Autos Used in Garage Business | Check the box (if applicable): Indicates the non-owned autos used in garage business option applies to the garage liability policy. |
| COVERAGES | Other | Check the box (if applicable): Indicates the other option applies for the garage liability policy. |
| COVERAGES | Describe Other | Enter text: The description of other coverage (not the limit) on the garage liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). |
| COVERAGES | Addl Insd | 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. As used here, applies to the garage liability policy. |
| COVERAGES | Subr Wvd | Enter Y for a “Yes” response. Input N for “No” response. Indicates subrogation has been waived on the policy. As used here, applies to the garage liability policy. |
| 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 garage liability policy number exactly as it appears on the policy, including prefix and suffix symbols. |
| COVERAGES | Policy Eff | Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. As used here, the garage liability policy effective date. |
| COVERAGES | Policy Exp | Enter date: The date on which the terms and conditions of the policy will expire. As used here, the garage liability policy expiration date. |
| COVERAGES | Auto Only Limit | Enter limit: The garage liability policy, auto only each accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). |
| COVERAGES | Ea Accident Limit | Enter limit: The garage liability policy, other than auto only each accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). |
| COVERAGES | Aggregate Limit | Enter limit: The garage liability policy, other than auto only aggregate limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). |
| COVERAGES | Insurer Letter | Enter code: The Company Letter of the insurer, as identified in the “Insurer(s) Affording Coverage” form section, associated with the garage keepers liability policy. |
| COVERAGES | Legal Liability | Check the box (if applicable): Indicates the legal liability option applies for the garage keepers liability policy. |
| COVERAGES | Direct Basis | Check the box (if applicable): Indicates the direct basis option applies for the garage keepers liability policy. |
| Section Name | Field Name | Field and/or Section Description |
| COVERAGES | Primary | Check the box (if applicable): Indicates the primary option applies for the garage keepers liability policy. |
| COVERAGES | Excess | Check the box (if applicable): Indicates the excess option applies for the garage keepers liability policy. |
| COVERAGES | Addl Insd | 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 | Subr Wvd | Enter Y for a “Yes” response. Input N for “No” response. Indicates subrogation has been waived on the policy. |
| 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 garage keepers liability policy number exactly as it appears on the policy, including prefix and suffix symbols. |
| COVERAGES | Policy Eff | Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. As used here, the garage keepers liability policy effective date. |
| COVERAGES | Policy Exp | Enter date: The date on which the terms and conditions of the policy will expire. As used here, the garage keepers liability policy expiration date. |
| COVERAGES | Comp/OTC | Check the box (if applicable): Indicates the comprehensive/other than collision option applies to the garage keepers liability limit. |
| COVERAGES | Loc | Enter number: The producer assigned identifier for the location number of the risk’s location. |
| COVERAGES | Limit | Enter limit: The garage keepers liability limit comp/optic or specified perils limit for this location. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as found on the policy declarations page. |
| COVERAGES | Specified Perils | Check the box (if applicable): Indicates the specified perils option applies to the garage keepers liability limit. |
| COVERAGES | Loc | Enter number: The producer assigned identifier for the location number of the risk’s location. |
| COVERAGES | Limit | Enter limit: The garage keepers liability limit comp/optic or specified perils limit for this location. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as found on the policy declarations page. |
| COVERAGES | Collision | Check the box (if applicable): Indicates the collision option applies to the garage keepers liability limit. |
| Section Name | Field Name | Field and/or Section Description |
| COVERAGES | Loc | Enter number: The producer assigned identifier for the location number of the risk’s location. |
| COVERAGES | Limit | Enter limit: The garage keepers liability collision limit for this location. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as found on the policy declarations page. |
| COVERAGES | Loc | Enter number: The producer assigned identifier for the location number of the risk’s location. |
| COVERAGES | Limit | Enter limit: The garage keepers liability collision limit for this location. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as found on the policy declarations page. |
| COVERAGES | Insurer Letter | 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. |
| COVERAGES | Commercial General Liability | Check the box (if applicable): Indicates the claims made or occurrence option applies for the general liability policy. |
| COVERAGES | Claims Made | Check the box (if applicable): Indicates the “claims made” option applies on the general liability policy. |
| COVERAGES | Occur | Check the box (if applicable): Indicates the general liability policy, occurrence basis applies. |
| COVERAGES | Other | Check the box (if applicable): Indicates other coverage not found on the form exists for the general liability policy. |
| COVERAGES | Describe Other | 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). |
| COVERAGES | Other | Check the box (if applicable): Indicates other coverage not found on the form exists for the general liability policy. |
| COVERAGES | Describe Other | 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). |
| COVERAGES | Policy | Check the box (if applicable): Indicates the general liability policy, general aggregate limit applies per policy. |
| COVERAGES | Project | Check the box (if applicable): Indicates the general liability policy, general aggregate limit applies per project. |
| Section Name | Field Name | Field and/or Section Description |
| COVERAGES | Loc | Check the box (if applicable): Indicates the general liability policy, general aggregate limit applies per location. |
| COVERAGES | Addl Insd | 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 | Subr Wvd | Enter Y for a “Yes” response. Input N for “No” response. Indicates subrogation has been waived on the policy. |
| 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 general liability policy number exactly as it appears on the policy, including prefix and suffix symbols. |
| COVERAGES | Policy Eff | Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. As used here, the general liability policy effective date. |
| COVERAGES | Policy Exp | Enter date: The date on which the terms and conditions of the policy will expire. As used here, the general liability policy expiration date. |
| COVERAGES | Each Occurance Limit | 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). |
| COVERAGES | Damage to Rented Premises Limit | 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). |
| COVERAGES | Med Exp Limit | 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). |
| COVERAGES | 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). |
| COVERAGES | General Aggregate Limit | 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). |
| COVERAGES | Products- Comp/Op Agg Limit | 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). |
| COVERAGES | Other | 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). |
| Section Name | Field Name | Field and/or Section Description |
| COVERAGES | Other Limit | 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). |
| COVERAGES | Insurer Letter | 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. |
| COVERAGES | Umbrella Liability | Check the box (if applicable): Indicates the type of policy is umbrella. |
| COVERAGES | Occur | Check the box (if applicable): Indicates “coverage trigger” is on an occurrence basis on an excess or umbrella liability policy. |
| COVERAGES | Excess Liability | Check the box (if applicable): Indicates the type of policy is excess. |
| COVERAGES | Claims Made | Check the box (if applicable): Indicates the “coverage trigger” is on a claims-made basis on an excess or umbrella liability policy. |
| COVERAGES | Deductible | Check the box (if applicable): This indicates whether a deductible or retention amount applies to the excess or umbrella liability policy. |
| COVERAGES | Retention | Check the box (if applicable): Indicates the excess or umbrella liability policy has an applicable deductible or retention amount. |
| COVERAGES | Retention Amount | Enter deductible: The excess or umbrella liability deductible or retention amount. |
| COVERAGES | Addl Insd | 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 | Subr Wvd | Enter Y for a “Yes” response. Input N for “No” response. Indicates subrogation has been waived on the policy. |
| 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 excess / umbrella policy number. |
| COVERAGES | Policy Eff | Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. As used here, the excess / umbrella policy effective date. |
| COVERAGES | Policy Exp | Enter date: The date on which the terms and conditions of the policy will expire. As used here, the excess / umbrella policy expiration date. |
| COVERAGES | Each Occurance Limit | Enter limit: The excess umbrella liability limit each occurrence limit. |
| COVERAGES | Aggregate Limit | 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). |
| Section Name | Field Name | Field and/or Section Description |
| COVERAGES | Other | 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). |
| COVERAGES | Other Limit | 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). |
| COVERAGES | Insurer Letter | 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. |
| COVERAGES | Any proprietor/partner/executive officer/member excluded? Y/N | 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. |
| COVERAGES | Subr Wvd | Enter Y for a “Yes” response. Input N for “No” response. Indicates subrogation has been waived on the policy. |
| 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 workers compensation policy number. |
| COVERAGES | Policy Eff | Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. As used here, the workers compensation policy effective date. |
| COVERAGES | Policy Exp | Enter date: The date on which the terms and conditions of the policy will expire. As used here, the workers compensation policy expiration date. |
| COVERAGES | WC Statutory Limits | Check the box (if applicable): Indicates that workers compensation statutory limits apply. |
| COVERAGES | 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. |
| COVERAGES | Limit | 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). |
| COVERAGES | 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). |
| Section Name | Field Name | Field and/or Section Description |
| COVERAGES | E.L. Disease- Ea Aemployee Limit | 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). |
| COVERAGES | 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). |
| COVERAGES | Insurer Letter | Enter code: The Company Letter of the insurer, as identified in the “Insurer(s) Affording Coverage” form section, associated with the other policy. |
| COVERAGES | Other Type of Insurance | Enter text: The description of the other policy not listed on the form. |
| COVERAGES | Addl Insd | 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 | Subr Wvd | Enter Y for a “Yes” response. Input N for “No” response. Indicates subrogation has been waived on the policy. |
| 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 policy number of the other policy. |
| COVERAGES | Policy Eff | Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. As used here, the effective date of the other policy, |
| COVERAGES | Policy Exp | Enter date: The date on which the terms and conditions of the policy will expire. As used here, the expiration date of the other policy. |
| COVERAGES | Other 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). |
| REMARKS | Remarks | Enter text: The Certificate Of Liability Insurance general remarks. The additional comments or special conditions that may exist upon the policy. Attach ACORD 101, Additional Remarks Schedule, if more space is required. |
| CERTIFICATE HOLDER | Certificate Holder | Enter text: The certificate holder’s full name. |
| CERTIFICATE HOLDER | Address Line 1 | Enter text: The certificate holder’s mailing address line one. |
| CERTIFICATE HOLDER | Address Line 2 | Enter text: The certificate holder’s mailing address line two. |
| CERTIFICATE HOLDER | City | Enter text: The certificate holder’s mailing address city name. |
| CERTIFICATE HOLDER | State | Enter code: The certificate holder’s mailing address state or province code. |
| CERTIFICATE HOLDER | Zip | Enter code: The certificate holder’s mailing address postal code. |
| SIGNATURE | 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. |