Certificate of Insurance Submission Form

General Certificate Details




**Select "Other" to report coverage for Builder's Risk, Installation Floater, Asbestos Abatement, Mold Remediation, Watercraft or any other type of coverage.
























Standard - Commercial General Liability (CGL)
Commercial General Liability: Occurrence Basis, Including Personal Injury, Property Damage, Broad Form Property Damage, Contractual Liability, Non-Owned Automobile Liability, Owner's and Contractor's Protective Coverage, Products - Completed Operations, Contingent Employers Liability, Cross Liability Clause and Severability of Interest Clause. 





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Contractors - Commercial General Liability (CGL)
Commercial General Liability: Occurrence Basis, Including Personal Injury, Property Damage, Broad Form Property Damage, Contractual Liability, Non-Owned Automobile Liability, Owner's and Contractor's Protective Coverage, Products - Completed Operations, Contingent Employers Liability, Cross Liability Clause and Severability of Interest Clause. 





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Standard - Motor Vehicle Liability (AUTO)

Automobile Liability - must cover all vehicles owned, or operated by, or on behalf of the insured.





Contractor - Motor Vehicle Liability (AUTO)

Automobile Liability - must cover all vehicles owned, or operated by, or on behalf of the insured.





Standard - Excess/Umbrella Liability (EL)

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Contractors - Excess/Umbrella Liability (EL)

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Professional Liability (PL)








Environmental Impairment Liability





Wrap-Up Liability






Standard - Other Liability (OL1)







Contractor - Other Liability (OL1)








Contractor - Other Liability (OL2)








Contractor - Other Liability (OL3)








Contractor - Other Liability (OL4)







Attachments




Any information which you provide on this on-line form will be kept confidential.

Personal information on this form is collected under the authority of the Municipal Act 2001, S.O. 2001, C.25 and will be used in maintaining evidence of insurance associated with the City of London. Questions about the collection of this personal information should be directed to the Manager, Risk Management, 300 Dufferin Avenue, London, ON N6A 4L9 519-661-CITY (2489) ext. 5435.