Standard Consultant Certificate of Insurance - DOC by Yr6TT4a

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									                                                                           Certificate of Insurance
                                                                           Sports Standard Form
This certifies that policies of insurance as described below have been issued to the Insured named below and are in full force and effect at this time. It is
understood and agreed that thirty (30) days' written notice of any cancellation or reduction in applicable limit of any of the policies listed below, with the
exception of ICBC, will be given to the holder of this certificate.

NOTE:         INSURANCE COMPANIES MUST BE LICENSED TO OPERATE IN CANADA.

This Certificate is issued to:   The City of Surrey, 14245 - 56 Avenue, Surrey, B.C. V3X 3A2

Insured:        Name:       Click here to enter text.
                Address:    Click here to enter text.

Broker:         Name:       Click here to enter text.                           Agent’s Name:      Click here to enter text.
                Address:    Click here to enter text.                                   Phone:     Click here to enter text.

Location, Project No. and nature of contract, permit, lease, license or operation to which this Certificate applies:

Click here to enter text.




                                                                                           Policy Term
Type of Insurance                                   Company and Policy Number              yyyy/mm/dd                    Limits of Liability/Amount
Section 1                                                                              From: Click here to       Bodily Injury, Death & Property Damage
Commercial General Liability                   Click here to enter text.               enter a date.
                                                                                       To:      Click here to    $Click here to enter text.
                                                                                       enter a date.             Per Occurrence
                                               ___________________ _                   ___________               $Click here to enter text.
                                                                                       From: Click here to       Aggregate
      Umbrella Liability                       Click here to enter text.               enter a date.             $Click here to enter text.
                                                                                       To:     Click here to     Deductible
                                               ____________________                    enter a date.             $Click here to enter text.
                                                                                       ___________               Umbrella Limit
      Excess Liability                         Click here to enter text.               From: Click here to       $Click here to enter text.
                                                                                       enter a date.             Excess Limit
                                                                                       To:     Click here to
                                                                                       enter a date.                        MINIMUM $2,000,000
Section 2                                                                              From: Click here to       Bodily Injury & Property Damage
Automobile Liability (owned or leased          Not applicable                          enter a date.
vehicles)                                                                              To:      Click here to    $Click here to enter text.    Limit
                                                                                       enter a date.
                                                                                                                               MINIMUM $3,000,000
Section 3                                                                              From: Click here to
Other:                                         Click here to enter text.               enter a date.             $Click here to enter text.    Limit
                                                                                       To:      Click here to    $Click here to enter text.    Deductible
                                                                                       enter a date.

                         Particulars of General Liability Insurance (Sections 1): X indicates that the coverage is included.
 City of Surrey as Additional Insured                       Incidental Medical Malpractice                Watercraft liability
 Premises & Operations                                       Host Liquor Liability                        Non-owned watercraft liability
    Products & Completed Operations                           Intentional Injury                           Broad Form Property Damage
   Owners & Contractors Protective                           Volunteers as Additional Insureds            Broad Form Tenants Legal Liability
   Blanket Contractual                                       Members as Additional Insureds               Advertising Liability
   Cross Liability/Severability of Interests
                                                              Injury to Participants (sporting events)   Contingent Employer’s
   Employees Additional Insureds
                                                           Occurrence Property Damage
   Non-Owned Automobile
                                                           Personal Injury

It is understood and agreed any deductible or reimbursement clause contained in the policy shall be the sole responsibility of the Named Insured.



                  (Authorized to Sign on Behalf of Insured)                                                          Date Signed




     (Authorized to Sign on Behalf of Insurers) and Brokers Stamp                                                    Date Signed




Jun 1, 2010

								
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