Form Acord 25 - Sample Certificate Of Liability Insurance - San Diego
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1
2The City of San Diego
SAMPLE CERTIFICATE OF INSURANCE AND
ADDITIONAL INSURED POLICY ENDORSEMENT FOR FILMING
A certificate of insurance and endorsement is required for any filming that takes place on City public
property or private property that requires a Filming Registration Form. The City reserves the right to require
additional insurance levels based on specific activities or equipment included in the production.
Coverage
•
Commercial General
Liability
•
Auto Liability
INSURANCE AGENT NAME
•
Proof of Workers
INSURANCE AGEND ADDRESS
Compensation
INSURANCE COMPANY NAME(S)
INSURED NAME
Minimum Limits
INSURED ADDRESS
For Filming or Still
Photography:
• $1,000,000 per
occurrence
• $2,000,000 aggregate
$1,000,000
CURRENT
POLICY
Additional Insured
POLICY PERIOD
NUMBER
$2,000,000
City of San Diego, its
officers, employees and
agents named as
POLICY
CURRENT
additionally insured.
$1,000,000
NUMBER
POLICY PERIOD
• If a policy contains
“blanket” additional
insured, then the
certificate must note:
“City of San Diego is
$1,000,000
additional insured by
$2,000,000
blanket endorsement”.
• If policy has no blanket
endorsement (see
$1,000,000
POLICY
CURRENT
following page for
sample).
NUMBER
POLICY PERIOD
$1,000,000
Insurance Company
•
Must be licensed to do
The City of San Diego, its officers, employees and agents as additionally insured.
business in California.
The City of San Diego
1200 Third Avenue, Suite 1000
San Diego, CA 92101
Certificate of Liability Insurance, Additional Insured Policy Endorsement and Proof of Worker’s Compensation must be
submitted with the Filming Registration Form.
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Parent category: Business