Can this form be signed electronically?

Yes. Electronic signatures meet federal legal standards under the ESIGN Act (15 U.S.C. ch. 96) and are recognized under UETA in most states, provided intent, consent, attribution, and record retention requirements are satisfied.

Is a scanned COI acceptable?

A scanned certificate is acceptable if it accurately reproduces the insurer-supplied COI and the verifier preserves an audit trail showing receipt, reviewer identity, and timestamps for evidentiary purposes.

Do I need a notary or witnesses?

Most insurance certificates do not require notarization. If the contract or state law requires notarized acknowledgements, follow the jurisdictional rule; some states or document types may require witnesses or notary signature.

How do I verify endorsements?

Confirm endorsement language names the certificate holder as additional insured and includes required primary/noncontributory language. When unclear, obtain endorsement copies or insurer confirmation in writing.

What if the COI expires during work?

Require renewals 30 days before expiration and specify consequences for lapses in the contract. Track expirations centrally and suspend work if continuous coverage is a contract condition.

How long must I retain COIs and forms?

Retain COIs for the contract term plus a period consistent with federal and industry rules: at least 3 years for tax records (IRC §6501(a)) and 6 years for HIPAA-related records (45 CFR §164.530(j)); state variation may extend these periods.

Electronic Signature
Templates
Insurance
Insurance Requirements Form

Insurance Requirements Form

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

INSURANCE REQUIREMENTS FORM

Client Name: Project/Contract:

Requirement Effective Date:

Applicant / Insured Information

Insured Name Doing Business As (if applicable) Address

Contact Person

Phone

Email

Date of Birth / Entity Formation Date

Policy Details

Primary Insurer

Broker / Agent

Policy Number

Policy Period From: To:

Required Coverages and Limits

The insured shall maintain the following minimum coverages. Check applicable coverage types and specify required limits below.

General Liability

Commercial General Liability (includes premises/operations, products/completed operations)

Per Occurrence: General Aggregate:

Automobile Liability

Business Auto Liability (owned, hired, non-owned)

Combined Single Limit:

Workers' Compensation & Employers' Liability

Workers' Compensation (as required by statute)

Employers' Liability Limit:

Professional / Errors & Omissions Liability

Professional Liability

Per Claim: Aggregate:

Umbrella / Excess Liability

Umbrella / Excess

Limit:

Additional Insured endorsement required in favor of the Certificate Holder
Waiver of Subrogation where permitted by law
Primary and Noncontributory wording required
Notice of Cancellation/Nonrenewal Days:

Exclusions

Insurer(s) shall disclose any policy endorsements or exclusions that materially limit coverage applicable to the operations or exposures described. Any deviation from the coverage requirements below must be noted and explained.

List policy exclusions or special endorsements

Documentation Checklist

The following documents must be provided to demonstrate compliance with these requirements.

Certificate of Insurance evidencing all required coverage, limits, endorsements and policy periods Copies of endorsements (additional insured, waiver of subrogation, primary/noncontributory) Full policy or declarations page when requested for review Loss runs for prior three years (if requested)

Additional documentation or notes

Beneficiary / Designation

Where applicable, designate beneficiary(ies) for policy proceeds that are required to be payable in accordance with contract terms.

Primary Beneficiary Name

Relationship

Percentage

Contingent Beneficiary Name

Declarations and Certifications

By signing below, the undersigned certifies that the information provided on this form is true and complete to the best of their knowledge. The undersigned further certifies that any insurance policies identified herein comply with the coverage types, limits and endorsements required by the client for the stated project or contract. The undersigned agrees to provide timely notice to the client of any material change, cancellation, nonrenewal, reduction of limits or restrictive endorsement affecting required coverage.

The insured authorizes release of insurance information to the client or the client's authorized representative for purposes of verifying compliance with contractual insurance requirements. Submission of a certificate of insurance does not alter, amend, or waive any policy terms unless confirmed by written endorsement issued by the insurer.

I certify that the insurance coverages described on this form will be maintained and that required documentation will be furnished upon request.

Applicant Printed Name:

By:

Date:

What an Insurance Requirements Form Is and when it's used

An Insurance Requirements Form specifies the insurance coverage a contractor, vendor, or tenant must maintain before beginning work or occupying property. It typically lists required policy types (general liability, professional liability, workers' compensation), minimum limits, additional insured endorsements, waiver of subrogation, and certificate of insurance (COI) submission instructions. The form establishes the contract-driven baseline for risk transfer and claims handling, helps procurement and risk teams verify coverage, and creates an auditable record of insurance obligations that parties must meet throughout a project or contract term.

Why an Insurance Requirements Form matters for contracts and risk control

Using a standardized Insurance Requirements Form clarifies insurance expectations, reduces coverage disputes, and protects the hiring party from uninsured loss exposure. It centralizes COI collection and creates a record useful for audits, claims, and compliance reviews, helping ensure contractors meet contractual and regulatory obligations.

Which roles typically prepare, review, and sign this form

The form is most often prepared by risk managers, procurement teams, or contract administrators before awarding work.

Risk Management teams that set coverage minimums and verify COIs for vendor compliance.
Procurement and contract administrators who include requirements in purchase orders and agreements.
Insurance brokers or carriers that supply and verify certificates and endorsements.

Review by legal or insurance brokers is common to confirm coverage language and endorsement acceptance.

Core elements to include in a professional Insurance Requirements Form

A complete form balances clarity with enforceability: list policy types, limits, required endorsements, certificate delivery instructions, effective dates, and any contract-specific conditions. Clear definitions reduce disputes and speed COI acceptance.

Policy Types

General, auto, workers' comp, professional, umbrella — specify required lines.

Minimum Limits

Per-occurrence and aggregate dollar amounts required for each policy line.

Endorsements

Additional insured, waiver of subrogation, primary and noncontributory language when needed.

Certificate Details

Required COI fields, issuer contact, and acceptable delivery methods.

Effective Dates

Policy period start and end; renewal notice timing and proof of continuous coverage.

Acceptance Criteria

Who approves COIs, escalation steps, and consequences for noncompliance.

Step-by-step: filling out and enforcing an Insurance Requirements Form

Complete the form and collect proof before work begins; verify endorsements and renewals periodically during the contract term.

01

Prepare Form: Populate contract specifics, required coverages, and limits.
02

Issue to Vendor: Send form with COI request and submission deadline.
03

Verify COI: Confirm policy numbers, dates, limits, and endorsements.
04

Approve or Escalate: Accept, request corrections, or withhold approval per contract terms.

Typical online workflow settings for collecting COIs and signatures

Configure your e-submission workflow to reduce friction and capture audit data required for legal enforceability and later review.

Field	Configuration
Signer Authentication	Email plus SMS code or knowledge-based authentication
Required Attachments	Certificate of Insurance PDF and endorsement images
Notification Timing	Immediate on upload and prior to policy expiration
Audit Trail	Capture IP address, timestamps, and signer identity

Typical lifecycle for e-submission and approval of an Insurance Requirements Form

A clear eWorklow routes the form from issuance to verification and approval while preserving an immutable audit record of actions.

Issue Requirement: Sender uploads form and specifies required COI items.
Vendor Response: Vendor uploads COI and endorsement documents.
Verifier Review: Risk or insurance admin checks coverage and endorsements.
Record & Store: Approved files and audit trail are archived for compliance.

Technical considerations for digital signing and COI submission

Choose a platform that supports fillable PDFs, audit trails, and integrations with your document systems.

File formats: PDF, DOCX, and image uploads supported
Integrations: Connectors for Salesforce, NetSuite, Google Workspace
Auth options: Email, SMS, or stronger multi-factor methods

Comparing common eSignature platforms for Insurance Requirements Forms

Platform selection affects per-user costs, bulk sending, audit capability, and HIPAA/enterprise compliance. signNow appears first for straightforward cost and feature comparison.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies by vendor	Varies by vendor	Varies by vendor	Varies by vendor
Bulk Send	Yes	Yes	Yes	Yes	Yes
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No cap	100 envelopes/user/year	Varies by plan	Varies by plan	Varies by plan

Essential data elements to collect on the form

Insurer: Carrier name

Policy Number: Exact policy ID

Coverage Lines: Liability/Auto/WC/etc.

Limits: Per-occurrence and aggregate

Policy Period: Start and end dates

Endorsements: Additional insured/waivers

Common timing expectations and notice windows

Set clear submission and renewal deadlines to avoid coverage gaps and contract breaches.

Before Work Begins:

COI must be received and approved prior to project start

Contract Execution:

COI or signed insurance form accompanies contract signature

Renewal Notice:

Renewal or new COI requested 30 days before expiration

Mid-Term Changes:

Require notification within 10–15 days of cancellation or change

Claims Reporting:

Follow insurer and contract claim notice timelines

Frequent mistakes to avoid when preparing or accepting the form

Accepting a COI without required endorsements, leaving coverage gaps that compromise risk transfer.
Failing to verify policy period dates, leading to uncovered work or retroactive coverage issues.
Allowing abbreviated or mismatched entity names that prevent insurer confirmation of coverage.
Not tracking renewals or expirations, which leads to lapsed coverage during ongoing work.

Consequences of incomplete or incorrect Insurance Requirements Forms

Contract Breach: Remedies or liquidated damages

Coverage Gaps: Uninsured loss exposure

Financial Penalties: Indemnity and recovery costs

Project Delays: Work stoppage pending compliance

Legal Liability: Increased litigation risk

Claim Denial: Insurer may decline coverage

Practical examples of digital COI collection in real organizations

Two condensed examples show how organizations use electronic forms and signatures to streamline COI collection and verification.

Optica Ventures — Property Management

Optica used an Insurance Requirements Form to require COIs for rental properties, improving compliance for new leases.

Collected certificates digitally at move-in to reduce manual follow-up.
Brian Fitzgibbons, COO, said: "The interface is simple and easy-to-use for our team; more importantly, it is just as easy for our customers." This reduced follow-ups and improved recordkeeping for every lease.

Martin Properties — Brokerage and Leasing

Martin Properties moved COI collection online to speed lease closings and centralize records.

Automated renewal reminders minimized lapses.
Tim Martin, Founder, said: "I can process and execute all of these documents online with 100% compliance and built-in security." The change cut turnaround time and lowered administrative overhead.

Frequently asked questions about Insurance Requirements Forms and e-signatures

Answers to common questions about electronic completion, legal validity, COI acceptance, and recordkeeping for Insurance Requirements Forms.

Need help? Contact support

Can this form be signed electronically?
Yes. Electronic signatures meet federal legal standards under the ESIGN Act (15 U.S.C. ch. 96) and are recognized under UETA in most states, provided intent, consent, attribution, and record retention requirements are satisfied.
Is a scanned COI acceptable?
A scanned certificate is acceptable if it accurately reproduces the insurer-supplied COI and the verifier preserves an audit trail showing receipt, reviewer identity, and timestamps for evidentiary purposes.
Do I need a notary or witnesses?
Most insurance certificates do not require notarization. If the contract or state law requires notarized acknowledgements, follow the jurisdictional rule; some states or document types may require witnesses or notary signature.
How do I verify endorsements?
Confirm endorsement language names the certificate holder as additional insured and includes required primary/noncontributory language. When unclear, obtain endorsement copies or insurer confirmation in writing.
What if the COI expires during work?
Require renewals 30 days before expiration and specify consequences for lapses in the contract. Track expirations centrally and suspend work if continuous coverage is a contract condition.
How long must I retain COIs and forms?
Retain COIs for the contract term plus a period consistent with federal and industry rules: at least 3 years for tax records (IRC §6501(a)) and 6 years for HIPAA-related records (45 CFR §164.530(j)); state variation may extend these periods.

be ready to get more

Join over 28 million airSlate SignNow users

Sign Now