CERTIFICATE OF INSURANCE

THIS IS TO CERTIFY TO:

(Landlord's name as it appears on lease)

123 Any Street

City, Ontario A1B 2C3

that Policy(ies) of insurance as herein described have been issued to the Insured named this date.

NAMED INSURED:

(Tenant's name as it appears on lease)
MAILING ADDRESS: ______________________________________________
______________________________________________

COVERAGE

Insurer & Policy

Limit

Policy Period

COMMERCIAL GENERAL LIABILITY

_________________

#________________

$_______________

____________  to

____________

Including

- Products and Completed Operations

- Personal Injury

- Occurrence Form

- Blanket Contractual

- Cross Liability/Severability of Interest Clause

- Non-Owned Automobile Liability

- Tenants Legal Liability (Broad Form)

 

 

 

 

 

 

 

 

 

_________________

#________________

 

$_______________

(Aggregate)

 

 

 

 

$_______________

 

 

 

 

 

 

 

____________  to

____________

ALL RISKS PROPERTY

- Including improvements, contents of every description

_________________

#________________

$_______________

____________  to

____________

BUSINESS INTERRUPTION

_________________

#________________

$_______________

____________  to

____________

THIRD PARTY LIABILITY

- Owned Vehicles

_________________

#________________

$_______________

____________  to

____________

UMBRELLA LIABILITY

- In Excess of Underlying Commercial General Liability and Third Party Automobile Liability Limits

_________________

#________________

$_______________

____________ to

____________

COVERING:

Risk Location: UNIT
Use of premises as: _________________________________________


NOTE:

It is agreed that (Landlord name as it appears on lease) is added as Additional Insured with respect to Commercial General Liability and Umbrella Liability and then only with respect to liability arising out of the operations of the Named Insured at the above noted project.

It is further agreed that (Landlord name as it appears on lease) will be given 30 days prior written notice of cancellation with respect to Commercial General Liability and Umbrella Liability and 15 days with respect to Third Party Liability (Owned vehicles), except where Statutory Conditions apply.

This Certificate of Insurance does not in any way amend or alter the terms, conditions and exclusions of the policies mentioned above.

Dated this _________ day of __________________ 20______ at the office of:

________________________________________________________

________________________________________________________

Tel:#________________________ Fax:#_______________________

 _________________________________
(Authorized Representative)