Example of a Certificate of Liability Insurance form, including the following annotations provided as instructional guidance to help users understand the key insurance requirements and important sections of the certificate form:
Top left annotation (red box around producer section): "Certificate of Liability Insurance (insurance card copy is not sufficient)" - This annotation emphasizes that a simple insurance card is inadequate and that this formal certificate document is required.
Middle left annotation (red box in coverages section): "General Liability insurance required at these levels" - This points to the general liability coverage requirements, specifically highlighting the $1,000,000 per occurrence and $2,000,000 aggregate limits shown in the adjacent coverage table.
Center annotation (red box in automobile liability section): "For a truck or vehicle, whether driven alone or for towing a Mobile Food Vehicle state minimum insurance is required" - This note clarifies vehicle insurance requirements for mobile food operations, indicating that standard state minimum coverage applies to vehicles used for mobile food service.
Lower center annotation (red box in workers compensation section): "Workers Compensation coverage is required if the licensee will have employees for the business (not just owners)" - This explains when workers compensation insurance is mandatory, clarifying that it's required when the business has employees beyond just the business owners.
Bottom left annotation (red box in description section): Points to the text "City of Boulder are additionally insured with insurance with respect to general liability" - This highlights the additional insured requirement for the City of Boulder.
Bottom annotation (red box around certificate holder information): Highlights "The City of Boulder, PO Box 791, Boulder, CO 80301" - This emphasizes where the certificate should be sent and who the certificate holder is.