Marcia Hultman

Cabinet Secretary

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Division of Insurance - Producer Information

Certificates of Insurance


Unless otherwise specified, the forms below are provided in Adobe .pdf format.*

Certificate of Property Insurance (COPI-01-10) Excel Adobe .pdf
Certificate of Liability Insurance (COLI-01-10) Excel Adobe .pdf


Bulletin(s) and Accompanying Notices About Certificates of Insurance

Bulletin 10-01

Certificates of Insurance Notice


Certficate of Insurance Facts

The disclosure and cancellation language contained on Acord 24 (2009/09), Acord 25 (2009/09), and ISO Form IL C 001 09 03 is compliant with Bulletins 09-05 and 09-06.

Acord 24 (1995/01) and Acord 25 (2009/01) that reflect an endorsement, amendment or reflect changes in the cancellation provision in the policy are not compliant with Bulletins 09-05 and 09-06. The following languae must be placed in the description section of these forms:

"The cancellation portion of this certifcate is left blank and no notice other than that provided by the policy is guaranteed, promised, or implied from the issuance of this certificate."

Bulletins 09-05 and 09-06 also apply to Evidence of Insurance for Personal Property and Commercial Property Coverages with similar cancellation language.

Accord Forms - Certificate Changes


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Contact the Division of Insurance