Preview

Insured Party Information

Insured Party Information

Entity Type Individual Person Corporation Limited Liability Company (LLC) Partnership Sole Proprietorship Trust Non-Profit Organization Government Entity

Select the type of entity

Full Legal Name

As it should appear on the document

Doing Business As (DBA)

Optional trade name

State of Formation Select state... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia

Where the entity was formed

Authorized Representative

Person authorized to sign

Representative Title

Title or position

Address

Street Address

Full street address including suite or unit number.

City

City of insured party residence or business.

State Select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia

State where this address is located.

ZIP Code

5-digit ZIP code.

Email Address

Used for correspondence and notices.

Phone Number

Best number for direct contact.

Requiring Party / Certificate Holder

Certificate Holder Information

Entity Type Individual Person Corporation Limited Liability Company (LLC) Partnership Sole Proprietorship Trust Non-Profit Organization Government Entity

Select the type of entity

Full Legal Name

As it should appear on the document

Doing Business As (DBA)

Optional trade name

State of Formation Select state... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia

Where the entity was formed

Authorized Representative

Person authorized to sign

Representative Title

Title or position

Address

Street Address

Full street address including suite or unit number.

City

City of certificate holder residence or business.

State Select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia

State where this address is located.

ZIP Code

5-digit ZIP code.

Email Address

Used for correspondence and notices.

Phone Number

Best number for direct contact.

Insurance Details

Insurance Carrier

The licensed insurance company issuing the policy. Verify the carrier's A.M. Best rating — "A" or better is typically required for commercial contracts.

Policy Number

The insurer-assigned policy number. Required for Certificates of Insurance (COIs) and verification of coverage.

Each Occurrence Limit ($) *

The maximum payout per single claim. $1 million per occurrence is the standard minimum for most commercial contracts and leases.

General Aggregate Limit ($) *

The maximum total payout for all claims during the policy period. Standard is 2× the occurrence limit (e.g., $2M aggregate / $1M per occurrence).

Products & Completed Operations Limit ($)

Covers claims arising from products sold or work completed. Required for contractors and product manufacturers — typically matches the aggregate limit.

Additional Insured Required Yes — certificate holder named as additional insured No — certificate holder is not additional insured

Being named as additional insured grants direct coverage under the policy if you are sued in connection with the insured's operations. Required by most commercial landlords and general contractors.

Policy Effective Date *

The start date of the policy period. Confirm no gap exists between this date and any prior policy expiration.

Policy Expiration Date

The date coverage ends. Many contracts require 30-day advance notice of cancellation to the certificate holder.

Review & Generate

Review your entries below before generating. Click Edit on any section to make changes.

Building your summary…

Document Preview

Refresh Preview Hide Preview

This is a preview of how your document will look. The final version will include complete legal language and state-specific provisions.

General Liability Insurance Agreement — Preview

Generating preview…

Everything looks good? Click Generate Document below to create your professional document instantly.

Previous Next Step Generate Document

Enable autosave (your progress will be saved locally)

Clear saved data

Not Legal Advice: This automated form assistance tool provides general information and document templates. It is not a substitute for legal advice from a qualified attorney. Laws vary by jurisdiction and change over time. Consult with a licensed attorney for advice specific to your situation.
Last updated: January 2026