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Certificate of Insurance (COI) Template

A fill-in certificate modeled on the ACORD 25 layout. Click any field to edit, then print or save as PDF. Nothing is stored — it stays in your browser.

CERTIFICATE OF LIABILITY INSURANCE
This certificate is issued as a matter of information only and confers no rights upon the certificate holder.
Date (MM/DD/YYYY)
09/04/2026
Producer (agency)
Your Agency Name
123 Main St, Suite 100
Anytown, ST 00000 · (555) 555-0100
Insured
Insured Business LLC
456 Commerce Ave
Anytown, ST 00000
Insurers affording coverage & NAIC #
Insurer A: Carrier Name — NAIC 00000  ·  Insurer B: Carrier Name — NAIC 00000
Coverages
Type of insurancePolicy numberEff. dateExp. dateLimits
Commercial General Liability GL-000000 01/01/2026 01/01/2027 Each occurrence $1,000,000 · General aggregate $2,000,000
Automobile Liability AU-000000 01/01/2026 01/01/2027 Combined single limit $1,000,000
Umbrella / Excess Liability UM-000000 01/01/2026 01/01/2027 Each occurrence $5,000,000
Workers' Compensation & Employers' Liability WC-000000 01/01/2026 01/01/2027 Per statute · E.L. each accident $1,000,000
Description of operations / locations / special items (attach ACORD 101 if more space is required)
Certificate holder is named as additional insured with respect to general liability per written contract. Waiver of subrogation applies where required by written contract.
Certificate holder
Holder Company Name
789 Property Rd
Anytown, ST 00000
Authorized representative
Signature on file

What a certificate of insurance is

A certificate of insurance (COI) is a one-page summary that proves a business carries coverage. The industry-standard form is the ACORD 25 for liability. It lists the insured, the carriers, each policy's number and dates, the limits, and the certificate holder who is being given proof.

This template reproduces the ACORD 25 layout so you can see the fields and print a working draft. It is not an official ACORD form and does not replace one — agencies issue live certificates from their agency management system, which pulls policy data automatically and keeps an audit trail of who received which COI.

Certificate of Insurance FAQ

The insurance agency or broker of record issues the certificate on the insured's behalf, drawing on the actual policies in force. The insured cannot alter coverage by editing a certificate — the COI only reports what the policies already provide.

No. This is a free layout modeled on ACORD 25 so you can draft and print a certificate quickly. Official ACORD forms are licensed and are generated by agency software. Use this to understand the fields, then issue the live certificate from your AMS.

An additional insured is a third party — often a landlord or client — extended some of the named insured's liability coverage, usually because a contract requires it. It is added by endorsement to the policy and then reflected in the certificate's description box.
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