Vandalia, IL · Fayette County
Certificate of Liability Insurance
This certificate records an insured party’s liability coverage and is completed by an insurance producer for submission to the certificate holder.
What this form is
The certificate summarizes insurance policies, coverage periods, limits, and the insured party for a named certificate holder. It includes sections for liability, auto, workers’ compensation, and other coverage, along with an authorized representative’s signature. Submit it when the city requests proof of liability insurance; the certificate itself says it conveys no rights or changes to the insurance coverage.
Who needs it
A business, contractor, or other insured party may need its insurance producer to complete this certificate when the city requests proof of liability coverage.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This certificate is signed by an authorized representative without a notary; the form includes no sworn attachment or notarized related step.
How to submit this form
- 1
Download The Certificate
Download the Certificate of Liability Insurance PDF.
- 2
Complete The Certificate
Provide the insured, insurer, policy, coverage, and certificate-holder information requested on the form.
- 3
Gather Insurance Details
Check the policy periods, coverage limits, and any operations or locations details to include.
- 4
Submit To The City
Submit the completed certificate to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What information does the certificate show?
- It lists the insured party, insurers, policy numbers and dates, coverage types, limits, and the certificate holder.
- Who completes the Certificate of Liability Insurance?
- The certificate has fields for the producer, insured, insurers, policy details, and an authorized representative. The form does not specify who must complete each field.
- Do I need a notary for this certificate?
- No. The certificate is signed by an authorized representative without a notary, and it includes no sworn attachment or notarized related step.
- How do I submit the certificate?
- Submit it to the city department named on the form; check the city website for current contact details.