Certificate of insurance sample, annotated
Below is a downloadable sample certificate of insurance on the ACORD 25 form — the format virtually every U.S. commercial COI uses. It's synthetic (no real company or policy), which makes it safe to share with vendors as an example of what you expect, and unusually complete: unlike most samples floating around, it includes the endorsement pages behind the certificate face.
What this sample shows that most don't
Read it top to bottom and you'll find every element a real compliance check cares about:
- PRODUCER block — the insurance agency that issued it (the people who actually re-issue certificates at renewal).
- INSURED — the vendor's exact legal name, which must match your contract.
- The coverage grid — general liability with each-occurrence and aggregate limits, auto liability, umbrella, workers comp, each with policy numbers and effective/expiration dates.
- ADDL INSD and SUBR WVD checkboxes — and, critically, the endorsement pages behind the certificate that actually back those checkboxes up (CG 20 10 and CG 20 37 additional insured forms, a CG 24 04 waiver of subrogation, and primary & non-contributory wording).
- CERTIFICATE HOLDER — the party the certificate is issued to.
How to use it
Send it to vendors as the model of an acceptable submission — especially the point that endorsement pages must be attached, since that's what most vendors' agents leave out. Use it to train new team members on what to check. Or upload it to a COI checker and see what an automated review extracts from every box in about a minute.
A sample is not a template
You can't fill this out yourself — only the vendor's insurance agent can issue a real certificate, because it summarizes their actual policies. If a vendor sends you a certificate they typed up themselves, that's a red flag worth escalating. What you CAN standardize is your requirements: the limits, coverages and endorsements you demand before work starts.
Frequently asked questions
Is this a real certificate of insurance?
No — it's a synthetic sample with fictional companies and policy numbers, built to mirror a complete, compliant ACORD 25 submission including endorsement pages. Real certificates are issued only by insurance agents.
Can I use this sample to show vendors what I need?
Yes, that's exactly what it's for. Pair it with your written insurance requirements so vendors' agents know the limits and endorsements to include.
Upload a certificate and see the verdict in about a minute — 14-day free trial, no card, no demo call.