Certificate of insurance request sheet

This is not a certificate — only a broker can issue one. It is the brief that makes the certificate come back right the first time, with the endorsement forms attached rather than merely mentioned.

Fill this in, print it, and send it to the broker. It asks for the endorsement documents, not just a line in the description box — which is the difference that decides claims.

Named insured (exact legal entity)

Certificate holder (exact legal entity)

Project or contract reference

Cover must start

Cover must run to

Each occurrence limit

General aggregate

Products / completed operations aggregate

Endorsements to request

Additional insured — ongoing operationsNames the holder for claims arising out of your work while it is in progress.
Additional insured — completed operationsExtends that status after the work is finished, which is when construction claims arrive.
Waiver of subrogationYour insurer gives up its right to recover from the holder after paying.
Primary and non-contributoryYour policy pays first and does not share with the holder's.
Notice of cancellation to the holderThe holder is told if the policy is cancelled mid-term.

Request to broker

Named insured: —
Certificate holder: —
Project: —
Cover period: — to —
Each occurrence: $1,000,000
General aggregate: $2,000,000
Completed operations: $2,000,000

Please attach the endorsement forms for:

· Additional insured — ongoing operations
· Additional insured — completed operations
· Waiver of subrogation
· Primary and non-contributory

A mention in the description box is not an endorsement. Send the form itself, with its form number, so the holder can confirm the cover exists on the policy rather than on the certificate.

Embossed relief of a bordered certificate blank with an empty seal recess

§ 1What this produces

A printable request naming the exact legal entities, the limits, the cover period and the endorsement forms you need attached. Hand it to your own broker, or send it to a subcontractor’s broker when you are the one collecting.

§ 2Why the endorsements are the point

Additional insured status, waiver of subrogation and primary-and-non-contributory are amendments to a policy, each with a form number. A sentence in the certificate’s description box is a sentence typed by a broker, and the disclaimer at the bottom of every ACORD 25 says the certificate confers no rights.

Mentioned versus endorsed
What you have	What it proves	At claim time
A line in the description box	Somebody typed it	Nothing to rely on
The endorsement form, with its number	The policy was amended	The cover exists
Completed-operations AI wording	Cover survives handover	Where construction claims land

§ 3If you are collecting them

Ask before the first day on site, diarise the expiry, and keep the file. A missing subcontractor certificate is not merely a compliance gap: at your workers’ compensation audit the carrier will generally treat what you paid that sub as your payroll and charge you for it, backdated across the policy year.

§ 4California's statutory floor

A licensed California LLC must carry liability insurance with a cumulative limit of at least $1,000,000, rising $100,000 per additional person of record up to $5,000,000 (B&P Code § 7071.19), written since 2014-01-01 by an admitted carrier. A certificate showing less than that is a licensing problem, not just a contractual one.

Checked against

CSLB — Limited Liability Company (LLC) licencesread 2026-09-04

Not legal advice. Fees, bond amounts and deadlines are set by statute and change without notice — confirm with the board that issues your licence before you file.