Topic: BASIC GUIDE FOR CHECKING Page 1 of 8

CERTIFICATES OF INSURANCE Date Issued: October 1, 1993

Section: LIABILITY/PROPERTY Date Revised:

INSURANCE PROGRAM

Number: XXIII.10.

PURPOSE:

To be used to determine whether Certificates of Insurance comply with stan-

dard County contract requirements. To use it, you only need to have a copy

of the Certificate of Insurance and the contract it applies to in front of

you. This guide will allow you to verify the correctness of most Certifi-

cates. Any types of insurance or language not covered in this document

should be discussed with Risk Management by contacting Ron Whipp or Janet

McKinley at 454-2240.

POLICY:

County contracts/agreements which contain insurance provisions typically

require contractor/vendors to provide Certificates of Insurance as evidence

of compliance.

County Procedures Manual Section 300, Title I-21 provides that each depart-

ment is responsible for obtaining and maintaining Certificates of Insurance

and overseeing compliance with the terms of the agreement.

THE ATTACHMENTS LISTED IN THIS PROCEDURE ARE NOT AVAILABLE THROUGH THE

MAINFRAME PERSONNEL DISK. YOU WILL BE ABLE TO REQUEST A PRINTED COPY OF

THESE ATTACHMENTS MAILED TO YOU THROUGH INTEROFFICE MAIL BY SENDING A PROFS

NOTE TO RON WHIPP AT PER501 OR JANET MCKINLEY AT PER510 OR BY CALLING

x2240. PRINTED COPIES ARE ALSO AVAILABLE IN THE RISK MANAGEMENT DIVISION OF

THE PERSONNEL DEPARTMENT.

PROCEDURE:

I. Types of Certificates

XXIII.10.

Page 2 of 8 BASIC GUIDE FOR CHECKING CERTIFICATES OF INSURANCE

There are three types of Certificates you will encounter 95% of the

time. Two are insurance industry forms called ACCORD forms and the

third is a State Compensation Insurance Fund form.

Attachment A to this procedure is a copy of an ACCORD 2.5S form. It

is the Certificate of Insurance form you will see most often, and may

be used for any of the types of insurance required by the County.

Although the most recent revision was July 1990, earlier dates are

acceptable.

Attachment B is an ACCORD 25 form. You may see this form, although it

is usually only used for a limited number of liability insurances

still written on older coverage forms. It is occasionally used by

smaller brokers who have not updated their supply. This form may show

insurances other than liability and is still acceptable to be used for

any type of insurance required by the County.

Attachment C is a State Compensation Insurance Fund (SCIF) form 10262,

which may only be used as evidence of Workers' Compensation coverage.

SCIF is an agency of the State of California that provides Workers'

Compensation coverage to small and medium sized companies which do not

purchase commercial insurance or self insure.

II. General Information

The County contract you are checking may require one or several types

of insurance policies and endorsements. The contractor may use differ-

ent insurance brokers for different types of insurance, therefore you

may receive more than one certificate for each contract. Each broker

will only list the types of insurance their agency places. Be sure

you have certificates which collectively show all the required cover-

ages and information.

If any certificate does not match the information contained in this

guide, you should call Risk Management (454-2240) as soon as possible

and speak to either Ron Whipp or Janet McKinley. They will assist you

in what additional actions need to be taken and answer any questions

you may have.

III. Checklist for Certificates (By Form)

A. ACCORD 25S

Please refer to Attachment A for the form and numbers referred to

in this checklist.

1. Producer

This should show the name and address of the insurance bro-

ker or insurance agent issuing the certificate.

XXIII.10.

BASIC GUIDE FOR CHECKING CERTIFICATES OF INSURANCE Page 3 of 8

2. Insured

This should show the correct name and mailing address of the

contractor.

3. Companies Affording Coverage and Company Letter

(Co Ltr)

Since several types of insurance may be shown on one form,

the name of the insurer providing each type of insurance is

beside one of the letters A -E. The letter assigned to each

insurer is then used in the "Co Ltr." box (left margin below

coverages) to show which insurer provides which coverage.

Both the "Companies Affording Coverage" and the "Co Ltr"

sections should be properly completed.

4. Policy Number

This section should be completed for any type of insurance

shown on the certificate.

5. Policy Effective Date

This should show the month, day and year the insurance poli-

cy was effective.

6. Policy Expiration Date

This should show the month, day and year the insurance poli-

cy will expire. IMPORTANT: This date should not be earlier

than the effective date of your contract. It is common for

the policy to expire during the contract term, however you

must calendar this date or in some other make sure that you

receive a new Certificate of Insurance prior to the termina-

tion date of the insurance. The Contractor should be in-

formed of this requirement.

7. Certificate Holder

The County of Santa Cruz, followed by your own department's

name and address should be in this box. This is the address

where certificates will be sent. IMPORTANT: Certificates

should be sent to and checked for accuracy by the department

issuing each contract. Do not have certificates sent to the

Auditor-Controller, Risk Management, County Counsel or the

County Administrative Office. If copies are needed by one

XXIII.10.

Page 4 of 8 BASIC GUIDE FOR CHECKING CERTIFICATES OF INSURANCE

of these offices, you may make a copy of the one sent to

your department. Each contract administrator (operating

department) is responsible for assuring County insurance

requirements are met.

8. Cancellation

The printed wording on the certificate should have been

modified by the broker to cross out the words "ENDEAVOR TO"

and the last sentence "BUT FAILURE TO MAIL SUCH NOTICE SHALL

IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COM-

PANY, ITS AGENTS OR REPRESENTATIVES". The words which

should be crossed out have been circled on Attachment A.

Additionally the blank before the word "DAYS" on the third

line should be filled in with the number "30". A greater

number than 30 is acceptable, numbers less than 30 are not,

without approval from Risk Management.

9. Authorized Representative

The certificate should be signed here. Facsimile signatures

are acceptable, but unsigned certificates are not.

10. General Liability Insurance

If the contract requires Commercial General Liability Insur-

ance, the box next to those words should be filled in with

an "X", along with either the box next to the words "CLAIMS

MADE" or the word "OCCURRENCE" to the right.

Next, look at the "LIMITS" column on the right hand side.

The figures in these boxes are in thousands, so that $1,000

on this certificate means $1,000,000 in coverage. The fig-

ures in the three boxes with the numeral "10" should show

the amounts required by your contract. This should be

$1,000, unless approval for lesser limits has been given by

Risk Management. The other boxes in this section may be

blank or have lower limits, unless your contract specifical-

ly requires certain limits for Products and Completed Opera-

tions coverage. In this case, the blank next to "PRODUCTS-

COMP/OP AGG" should be filled in with the limit required.

NOTE 1: If the limits in the boxes marked "10" for General

Liability coverage are less than the contract requirements,

look to see if there is additional coverage in the section

labeled "EXCESS LIABILITY". If this is the case, add the

numbers in the boxes in the right hand column for "EXCESS

LIABILITY" to the corresponding "GENERAL LIABILITY" numbers.

If the total equals or exceeds the required amount in your

contract, the certificate is acceptable.

XXIII.10.

BASIC GUIDE FOR CHECKING CERTIFICATES OF INSURANCE Page 5 of 8

NOTE 2: County contracts generally require coverage for (a)

bodily injury, (b) personal injury, (c) broad form property

damage (d) contractual liability, and (e) cross liability.

If the box next to "COMMERCIAL GENERAL LIABILITY" has an

"X", you may assume the insurance has these coverage. If

not, please call Risk Management.

11. Automobile Liability Insurance

We are only concerned with vehicles or mobile equipment

which are used in accomplishing the contract. If your con-

tract requires Automobile Liability, then this section

should be completed. An "X" in the box next to the words

"ANY AUTO" is acceptable. Any other boxes, may or may not

be acceptable depending on which vehicles the Contractor

will use in connection with the contract. Please refer to

notes a - e below if boxes other than "ANY AUTO" are filled

in, otherwise skip to the paragraph after those items.

a. "ALLOWED AUTOS" means only those vehicles which the

Contractor owns or leases long term are covered. This

box alone is not acceptable if the Contractor will use

borrowed, rented or employee vehicles.

b. "SCHEDULED AUTOS" means only those vehicles which have

been specifically listed in the policy are covered.

This is not acceptable if any of the vehicles to be

used are not on the list, or if borrowed, rented or

employee vehicles are used.

c. "HIRED AUTOS" means rented or leased vehicles. This

alone is not acceptable if employee-owned, borrowed or

company owned vehicles are used.

d. "NON-OWNED AUTOS" means vehicles owned by employees or

others. This alone is not acceptable if company-owned

or leased or rented vehicles are used.

e. "GARAGE LIABILITY" is only relevant for Contractors who

store vehicles owned by others.

Next, look at the "LIMITS" column on the right margin. The

box beside the words "COMBINED SINGLE LIMIT" should be

filled in with an amount equal to or greater than that re-

quired in the contract, unless the contract has been modi-

fied. Often, contracts are modified when the Contractor is

an individual using her/his own vehicle. If this is the

case, you will likely receive a different certificate form

showing the policy limits per person and per occurrence for

XXIII.10.

Page 6 of 8 BASIC GUIDE FOR CHECKING CERTIFICATES OF INSURANCE

bodily injury, with separate limits for property damage. If

you are uncertain whether what is shown complies with the

contract, contact Risk Management.

12. Workers' Compensation and Employers' Liability

If the contract requires Workers' Compensation Insurance,

there should be a company letter in the left margin and an

"X" should be in the box next to the "STATUTORY LIMITS". The

other boxes in this section refer to Employers' Liability

Insurance, which is not required.

13. Professional Liability

If the contract requires Professional Liability (or Errors

and Omissions) Insurance, this coverage will be shown in the

"OTHER" section below "WORKERS' COMPENSATION AND EMPLOYERS'

LIABILITY". The limits for this coverage should be shown in

the blank section on the right of this section and should be

equal to or greater than what is required by the contract.

14. Additional Insured Language

If the contract requires "The County of Santa Cruz, its

officials, employees, agents and volunteers" to be added as

an additional insured as respects to the operations and

activities of or on behalf of the Contractor (or named in-

sured), that wording should be entered in the section titled

"DESCRIPTION OF OPERATIONS (LOCATIONS) VEHICLES/SPECIAL

ITEMS" or shown on a separate sheet attached to the certifi-

cate. If no agents or volunteers are involved in contract

activities, a certificate may be accepted without those

words. Also the words "as respects to the operations and

activities of or on behalf of the named/insured" may be

omitted, since they limit, not broaden, coverage.

15. Issue Date

The month, day and year the certificate was issued should

appear in the box in the top right corner.

B. ACCORD 25 Form Certificate of Insurance

Please refer to Attachment B for the form and numbers referred to

in this checklist. Since most of the form is the same as an

ACCORD 25S, only those numbers which are different are described

below. Please follow the ACCORD 25S checklist for other numbers

not discussed in this section.

10. General Liability Insurance

XXIII.10.

BASIC GUIDE FOR CHECKING CERTIFICATES OF INSURANCE Page 7 of 8

If the contact requires Comprehensive or Commercial General

Liability Insurance, a company letter should appear and an

"X" should appear in the boxes titled "COMPREHENSIVE FORM",

"PREMISES/OPERATIONS", "CONTRACTUAL", "BROAD FORM PROPERTY

DAMAGE" and "PERSONAL INJURY". These boxes are below the

words "GENERAL LIABILITY". Cross liability is included in

the comprehensive form. If the contract specifies other

coverages, these should also be confirmed by an "X" in the

appropriate box.

Look at the "LIMITS" boxes on the right side of the certifi-

cate. The figures in these boxes are in thousands, so that

$1,000 on this certificate means $1,000,000 limits. The

figures in the three boxes with the numeral "10" should show

the amounts (or higher) required by your contract. This

should be $1,000 or more unless approval for lesser limits

has been given by Risk Management. If the four boxes above

these are filled in instead, that is acceptable, as long as

the figures equal or exceed what is required in your con-

tract. The "PERSONAL INJURY AGG." box must also be filled

in with the same limit.

NOTE 1: If the limits in this section are less than the

contract requirement, look to see if it is additional cover-

age in the section labelled "EXCESS LIABILITY". If this is

the case, add the numbers in the boxes in the right hand

column for "EXCESS LIABILITY" to the corresponding "GENERAL

LIABILITY" numbers. If the total equals or exceeds the

required amount in your contract, the certificate is accept-

able.

11. Automobile Liability Insurance

Follow the checklist for the ACCORD 25S except that a dis-

tinction is made on the ACCORD 25 for "ALL OWNED AUTOS",

between private passenger vehicles and other than private

passenger vehicles. Also, there is no box for "SCHEDULED

AUTOS" - instead the blank box at the bottom would be used

for this purpose.

C. State Compensation Insurance Fund Form 10262

If the contract requires Workers' Compensation Insurance, you may

receive the certificate instead of an ACCORD 25 or 25S. Please

refer to Attachment C and check the following numbers:

1. Space for your department's address

XXIII.10.

Page 8 of 8 BASIC GUIDE FOR CHECKING CERTIFICATES OF INSURANCE

This should be accurately completed. Certificates should be

sent to your department's name and address. Do not have

certificates sent to the Auditor-Controller, Risk Manage-

ment, County Counsel or the County Administrative Office. If

copies are need by one or more of these offices, you may

make a copy of the one sent to your department. Each con-

tract administrator (operating department) is responsible

for assuring County insurance requirements are met.

2. Employer

This section should show the accurate name and address of

the Contractor.

3. (Date)

The certificate should be dated, if not here, somewhere

else.

4. Policy Number and Certificate Expiration

The policy number and date of expiration should be shown

here.

***

PAM2310 RFT F1 01/10/01

XXIII.10.

BASIC GUIDE FOR CHECKING CERTIFICATES OF INSURANCE Page 9 of 8

Attachments A, B and C

Attachments A, B and C are of a nature that cannot be stored in OPRI.

Please contact Janet McKinley at 454-2240 for copies of these attachments.