1.

Date of Attached Certificate of Insurance (COI):

(Ideally, the COI date should be not more than ten days after the effective date of the Supplier Agreement.)   Effective Date of Supplier Agreement:           

Date                 

2.

Is the “Named Insured” (near the top left of the form) the same as the name of the Supplier?

Yes       

No       

3.

Does the COI accurately list each type of insurance required by the Supplier Agreement?

Yes       

No       

4.

Are the liability limits equal to or greater than those required by the Supplier Agreement?

Yes       

No       

5.

Are the expiration dates far enough in the future to cover the period the Supplier will be providing services/products?  [A new COI will be required after the COI expiration date].

Yes       

No       

6.

Does the COI name the Buyer as “Certificate Holder”?    Find this box near the lower left hand corner.  Variations of the Buyer’s name are unacceptable.  

Yes       

No       

7.

Does the COI contain the proper “Endorsements” as required by the Supplier Agreement? [e.g. waiver of subrogation, primary insured, additional insured party, etc].

Yes       

No       

8.

Does the COI (in the bottom right box) provide for 30 days advance notice of any modification, change or cancellation of coverage? [The exact time period may vary based on the requirement in the Supplier Agreement].

Yes       

No       

9.

Is the COI addressed correctly to the appropriate Buyer’s office so that the Buyer will receive timely notice of a policy change or cancellation?

Yes       

No       

10.

Is the COI properly signed?

Yes       

No       

11.

If any of these above 10 items are answered “NO”, require the Supplier and/or Issuer to revise the COI.

Yes       

No       

12.

Does Supplier have lower-tier subs?

(If so, do those lower-tiers subs meet Supplier’s  insurance requirements?)

Yes       

Yes       

No       

No