Sample Forms

Below are examples and explanations of common forms used in conjunction with insurance requirements on contracts.

See Insurance Requirements for more information

Index of Forms

• Auto
  
  • Auto Liability Pollution (Sample Form 12)
  • Evidence of Insured Status (Sample Form 15)
  • MCS-90 (Sample Form 11)
• Additional Insured
  
  • Completed Operations (Sample Form 5)
  • Designated Person or Organization (Sample Form 7)
  • Engineers, Architects or Surveyors not Engaged by the Named Insured (Sample Form 16)
  • Managers or Lessors of Premises (Sample Form 9)
  • Ongoing Operations (Sample Form 4)
  • Ongoing and Completed Operations (Sample Form 6)
  • Owners, Lessees or Contractors - Automatic Status When Required in Construction Agreement (Sample Form 18)
  • Permits (Sample Form 13)
  • Vendors (Sample Form 8)
• Certificates of Insurance
  • Certificate of Liability Insurance (Sample Form 1)
  • Certificate of Property Insurance (Sample Form 10)
• Primary and Non-contributory
  
  • Primary and Non-contributory (Sample Form 14)
• Waivers of Subrogation
  
  • General Liability Waiver of Subrogation (Sample Form 3)
  • Workers' Comp Waiver of Subrogation (Sample Form 2)
• Workers' Compensation
  
  • Declaration of “No Employees” (Sample Form 17)
  • Workers' Comp Waiver of Subrogation (Sample Form 2)