This certificate of insurance sample is a filled-in ACORD 25, the "Certificate of Liability Insurance" most contractors and vendors send. Each box below has a sample entry and a note on what to check. After that come the five problems this sample hides, and what to ask the agent for. Keep it open the next time a subcontractor's certificate lands in your inbox and you have to decide whether it's good enough.
Everything in the sample is made up, the contractor and every policy number included. It's laid out as plain tables, not as a copy of the ACORD form. To see the blank form, New York's insurance department publishes an ACORD 25 specimen. If you need the basics first, like who issues a COI and what it can't do, start with What Is a Certificate of Insurance?
The scenario behind this certificate of insurance sample
You're the office manager at Ashford Lane Builders Inc., a general contractor. You've hired Brindle Creek Drywall LLC for an interior build-out that runs from November 2, 2026 to April 30, 2027. Their agent has just emailed you an ACORD 25.
Your subcontract has an insurance clause. Here's what it asks for in this example. The figures are only there to illustrate the review, so don't read them as a recommendation:
| Coverage | What the contract requires |
|---|---|
| General liability | $1,000,000 each occurrence, $2,000,000 general aggregate applying per project, occurrence form. Ashford Lane added as additional insured, with a waiver of subrogation. |
| Auto liability | $1,000,000 combined single limit, covering any auto. |
| Umbrella | $2,000,000. |
| Workers' comp and employers' liability | Statutory workers' comp. Employers' liability $1,000,000 each accident, each employee and policy limit. Waiver of subrogation. |
A certificate is only "right" or "wrong" against what you asked for, so keep your own contract open when you review a real one.
Top of the ACORD 25: date, producer, insured and insurers
| Box | Sample entry | What to check |
|---|---|---|
| Date | 10/19/2026 | The day the certificate was issued. An old or missing date is a warning sign. |
| Producer | Main Street Example Insurance Agency, 100 Example Road, Anytown, ST 00000 | The agent or broker who arranged the insurance and issued the certificate. Ideally it's the same agency that emailed it to you. |
| Contact name, phone, email | Dana Lee, (555) 010-0100, [email protected] | Your person for questions and corrections. The email should belong to the same agency that sent the certificate. |
| Insured | Brindle Creek Drywall LLC, 22 Sample Street, Anytown, ST 00000 | Must match the legal name on your subcontract. A parent or sister company is a different insured, and a trade name on its own doesn't show the legal entity you contracted with. |
| Insurer A to F | A: Example Casualty Insurance Co.; B: Sample Mutual Insurance Co.; C: Illustration Indemnity Co. | Each insurer gets a letter, which reappears in the coverage rows to show who insures what. |
| NAIC # | 00001, 00002, 00003 (fictional) | The National Association of Insurance Commissioners' number for each insurer, handy when two have similar names. Look one up in the NAIC's Consumer Insurance Search. |
The two blocks of capital letters above the producer box are standard notices, explained in our COI guide. In short, a mark in any box on this form is the agent's statement. It doesn't prove the coverage itself.
The edition is printed at the bottom of the page, such as "ACORD 25 (2016/03)" or "ACORD 25 (2025/12)". Our sample uses 2025/12, and that changes how you read the limits (there's a section on it further down).
The coverages grid, row by row
The middle of the ACORD 25 is a grid with one row per policy. Above it, the producer assigns a certificate number and a revision number (in our sample, 2026-0412, revision 1). Quote them when you call the agency.
The columns are the same on every row:
- INSR LTR: the letter of the insurer for that policy (A, B, C). Every coverage your contract requires needs one.
- ADDL INSD: marked ("Y" or "X") when the agent shows additional insured status on that policy.
- SUBR WVD: marked ("Y" or "X") when the agent shows a waiver of subrogation.
- Policy number: should be filled in on every row. If one is blank, push back.
- Policy effective and expiration dates: every policy should be in force on your start date.
- Limits: the dollar amounts, which differ by coverage.
Commercial general liability
General liability answers claims that the contractor's work or premises caused bodily injury or property damage to someone else.
| Item | Sample entry | What it means |
|---|---|---|
| Insurer, ADDL INSD, SUBR WVD | A, Y, Y | Example Casualty insures it. The agent shows you as additional insured and the waiver as granted. |
| Policy and dates | GL-000123-26, 02/01/2026 to 02/01/2027 | In force when the job starts, but it expires three months before the job ends. |
| CLAIMS-MADE or OCCUR | OCCUR | Occurrence responds to incidents that happen during the policy period; claims-made, to claims made during it. Check which your contract asks for. |
| Each occurrence | $1,000,000 | The most the policy pays for any one incident. |
| Damage to rented premises | $100,000 | Damage to premises the contractor rents. |
| Med exp | $5,000 | Medical payments to one person injured on their premises or by their operations, regardless of fault. |
| Personal and adv injury | $1,000,000 | Claims like libel, slander or invasion of privacy. You'll rarely care about this one. |
| General aggregate | $2,000,000 | The most the policy pays in total during the policy period, however many claims there are, except claims from finished work or products, which have their own aggregate below. |
| Aggregate applies per | POLICY | Whether that $2,000,000 is shared by all the contractor's jobs (policy) or applies separately to each project or location. Per project or location is better for you. |
| Products-comp/op agg | $2,000,000 | The total for claims arising after the work is finished. |
Automobile liability
Auto liability covers accidents involving the contractor's vehicles. Five checkboxes decide which vehicles count, and the Wellesley College certificate guide ties each one to the symbol used on the auto policy:
- ANY AUTO (symbol 1): any vehicle, whoever owns it.
- OWNED AUTOS ONLY (symbol 2): vehicles the contractor owns.
- SCHEDULED AUTOS (symbol 7): only the vehicles listed on the policy.
- HIRED AUTOS ONLY (symbol 8): vehicles they lease, rent or borrow.
- NON-OWNED AUTOS ONLY (symbol 9): vehicles they don't own, such as employees' cars used for work.
In our sample, Insurer A, policy BA-000124-26, runs 02/01/2026 to 02/01/2027 with a $1,000,000 combined single limit (bodily injury and property damage together, per accident). The only boxes checked are HIRED AUTOS ONLY and NON-OWNED AUTOS ONLY. If you've watched their own vans pull up to your site, that's a problem.
Umbrella or excess liability
Umbrella and excess policies add limits on top of the policies above. An excess policy follows the policy beneath it. An umbrella can sit over several policies at once and can be broader, which is why a deductible or retention (the amount the contractor pays first) may appear here.
Sample entry: Insurer B, UMBRELLA LIAB, OCCUR, policy UMB-000125-26, 02/01/2026 to 02/01/2027, $2,000,000 each occurrence, $2,000,000 aggregate, retention $10,000. That one matches the contract.
Workers' compensation and employers' liability
Workers' comp pays the contractor's own employees for work injuries; employers' liability covers lawsuits connected to them. Three things on this row don't appear anywhere else on the form:
- PER STATUTE or OTH-ER. PER STATUTE means the policy pays the benefits the state's workers' comp law requires. If OTH-ER is checked instead, see whether your contract accepts it.
- A Y/N box asks whether any proprietor, partner, executive officer or member is excluded. "Y" means some owners aren't covered by this policy. The form says the answer is mandatory in New Hampshire and that a "Y" should be explained in the description box.
- Employers' liability gets three limits instead of one: each accident, disease per employee and disease policy limit.
In our sample, workers' comp is with Insurer C: SUBR WVD "Y", policy WC-000126-25, 11/15/2025 to 11/15/2026, PER STATUTE checked, owner excluded "Y", employers' liability $1,000,000 / $1,000,000 / $1,000,000.
The blank row
The last row is open for other coverage, such as professional or pollution liability. Ours is empty. That's fine, because the contract doesn't ask for anything else.
Bottom of the form: description, certificate holder, cancellation
| Box | Sample entry | What to check |
|---|---|---|
| Description of operations / locations / vehicles | Maple Avenue clinic interior build-out, subcontract #ALB-2026-118. Blanket additional insured applies to general liability where required by written contract. Waiver of subrogation applies to GL and WC. Owner Sam Ortiz excluded from workers' compensation. | Project, location or contract references, plus notes on additional insureds, waivers and exclusions. When it runs long, the agent attaches an ACORD 101 (Additional Remarks Schedule). A note here doesn't replace the endorsement. |
| Certificate holder | Ashford Lane Builders Inc., 400 Example Boulevard, Anytown, ST 00000 | Your exact legal name and address. A person's name or a department isn't enough. |
| Cancellation | Standard wording: notice follows the policy provisions | This doesn't promise you any notice. As certificate holder, you may never hear that a policy was cancelled. |
| Authorized representative | Signed by Dana Lee | Someone at the agency or insurer who is authorized to sign. A blank signature, or a certificate the contractor signed, goes back for correction. |
What this certificate of insurance sample gets wrong
At a glance the sample looks fine. The names are right, the limits match and every coverage the contract asks for is listed. It's the kind of certificate that gets filed without a second look. Read it against the contract, though, and five things need attention: four need an answer before Brindle Creek starts work, and one is a date to track.
| What you spotted | Where | What to ask for |
|---|---|---|
| Workers' comp expires 11/15/2026, two weeks into the job. GL, auto and umbrella expire 02/01/2027, also before the job ends. | Expiration dates | Nothing yet. Note 11/15/2026 as the date to chase and ask for the renewed certificate a few weeks before. Then do the same for 02/01/2027. |
| The general aggregate applies per policy, and the contract asks for per project. | GL, aggregate applies per | Ask the agent whether the policy has a per-project aggregate. If it doesn't, whoever owns the contract decides whether to accept it. |
| Only hired and non-owned autos are covered, and the contract asks for any auto. Their own vans aren't shown. | Auto checkboxes | A corrected certificate showing ANY AUTO, if the policy has it. If it can only add OWNED AUTOS ONLY, whoever owns the contract decides whether that's acceptable. |
| ADDL INSD and SUBR WVD say "Y", and the description repeats it, but no endorsement came with the certificate. | GL and WC rows, description | Copies of the additional insured endorsement and the waiver of subrogation endorsements. |
| The owner is excluded from workers' comp. | WC owner/officer box, description | Ask whether the owner will work on your site. If so, check what your contract and your state's rules say about owners who aren't covered. |
Most of these are plain questions, and the agent can answer or fix them. Put the four questions in one email so you aren't trading messages for a week.
The ACORD 25 (2025/12) edition and its limits wording
New York's insurance department lists the ACORD 25 (2025/12) as approved on November 13, 2025. According to Big I New York, the main change is in the paragraph above the coverages grid. The older edition ends it by warning that paid claims may have reduced the limits shown. The new one, Big I New York reports, adds that limits shown are "inclusive of amounts requested by the certificate holder" and may not reflect higher policy limits. An asterisk notes that the last two sentences don't apply in Wyoming.
Going by that report, a certificate on the new edition may show the limits you asked for rather than the policy's full limits. In a response published by the Big "I", ACORD says the language is optional and that limits shown must still be accurate and available under the policy. The Big "I" still recommends that agents show the policy's limits.
In practice:
- Limits that match your requirements exactly, as in our sample, may be the requested amounts. That's fine for the contract check, which only asks whether they meet your minimums.
- If you need the policy's actual limits, say the umbrella's full size on a bigger job, ask the agent.
- If a certificate arrives on a very old edition, ask about that too. ACORD's certificates FAQ says withdrawn editions aren't kept up to date with regulations and shouldn't be used.
ACORD 24 and ACORD 23: when you need a different certificate
The ACORD 25 is for liability insurance. ACORD's FAQ explains that property and liability get separate certificates, partly because the insurer's cancellation notice duties differ. Two others you may run into:
| Form | Title | Use it when | What's different |
|---|---|---|---|
| ACORD 24 | Certificate of Property Insurance | You need proof that property is insured: a building, its contents, or equipment you've leased out. | Location and description of the property. Rows for property, inland marine, crime and equipment breakdown, with causes of loss (basic, broad, special), deductibles, and building, personal property and business income limits. |
| ACORD 23 | Vehicle or Equipment Certificate of Insurance | You lease, rent or finance one specific vehicle or machine to someone and need your interest shown. | Year, make, model, VIN or serial number and value. Vehicle liability plus collision and comprehensive. An additional interest box names you as additional insured, loss payee or lender's loss payable. |
The ACORD 23 itself says liability on multiple vehicles belongs on an ACORD 25. If you asked for one form and got another, ask for the right one. A property certificate says nothing about liability coverage, and a liability certificate says nothing about property.
After the review: write down the expiration dates
Once the corrected certificate and endorsements check out, file them and note two dates: 11/15/2026 for workers' comp and 02/01/2027 for the rest. On those days the certificate stops proving anything.
With a few subcontractors, a spreadsheet column per policy works. With dozens, the follow-ups slip. ExpirationPilot keeps each certificate's expiration date in one list and emails the person responsible 30, 14 and 7 days before by default. It can also email the contractor an upload link for the renewed certificate and follow up once a week, up to six times, until a file arrives. The tool doesn't read coverage, so someone on your team still reviews each certificate the way you just did.
Quick answers
Is there a free certificate of insurance template I can fill in?
Not one that does the job. ACORD forms are licensed to agents and brokers, and the contractor's agent or insurer issues the certificate. A certificate the contractor filled in from a template proves nothing about their coverage. Ask their agent for one.
What is an ACORD 25 certificate of insurance used for?
It's the standard form for showing liability coverage on one page: general liability, auto, umbrella or excess, and workers' comp with employers' liability. It's what you'll usually get when you ask a contractor or vendor for a COI.