ACORD 855 NY (2014/05) – Certificate of Liability Addendum

ACORD 855 (2014/05)

Certificate of Liability Addendum Form

Form Number:

ACORD 855 (2014/05)

Category:

Commercial Insurance

Last Updated:

May 2015

Page Count:

02 Pages

File Format:

PDF, Fillable PDF

Download Form Fill Form

ACORD 855

When working on construction projects in New York, accurate insurance documentation is compulsory. The Acord 855 form is used as an official addendum to the Acord 25 (Certificate of Liability Insurance), specifically designed to meet New York compliance standards. Additionally, the form ensures that contractors, subcontractors, project owners, and insurers have a clear summary of liability insurance and proper verification of coverage. For easier access and submission, you can download or fill it out online at AcordForm.net.

Form Preview

Benefits of Acord 855 NY PDF

Enhanced Transparency

The Acord 855 enhances transparency between parties by attaching it to the Acord 25 certificate with a clear overview of coverage without requiring a full policy.

Certificate Tracking

The form allows project owners, insurers, contractors, and subcontractors to track updates with a unique certificate number and revision number to avoid outdated certificates.

Insurer Status

It lets insurers specify whether they’re admitted in New York or operating as an Excess Line/FTZ carrier, ensuring the insurer’s legal standing.

Key Sections of The Acord Certificate of Liability Insurance Addendum

Agency and Insured Section

This section describes the insurance agency and the name insured, such as contractors or subcontractors. It includes policy number, NAIC code, effective date, and insured name.

Certificate and Revision Number

It tracks version history for updates, specifying the certificate number and revision number.

Insurer Status

The section specifies the legal status of the insurance company in New York.

Liability Coverage

It specifies excess liability, general liability, and other applicable coverage.

How To Complete The Acord 855 Fillable Form?

  1. Insurance Information: Start with the agency name, policy number, NAIC code, effective date of application, and insured name.
  2. Addendum Information: Specify the certificate number, revision number, and insurer status to choose whether the insurer is authorized in New York, and coverage confirmation to verify that the liability insurance limits and provisions. Moreover, answer all required questions.
  3. Attachment Requirements: Attach the completed form to the standard Acord 25.
  4. Signature: The authorized representative must sign and date the form.
Download PDF Fill Online Print Form

Frequently Asked Questions

The New York construction certificate of liability insurance addendum is a standardized document, which is a required addendum to the Aocrd 25 (certificate of liability insurance), providing additional compliance information, required explicitly under New York construction law.

The form clearly specifies that it is an informational only and does not amend, extend, or replace coverage. Therefore, it doesn’t replace the Acord 25.

It indicates whether this is the original certificate or an updated version, helping prevent confusion by ensuring all parties are referencing the most current insurance documentation.

Failing to provide the Acord 855 form may result in delays or denials in project approvals, contract compliance, or insurance verification.

Related Forms

Commercial Insurance

ACORD 75

It works as a binding contract between the insured and the insurer, describing coverages, limits, and conditions.

ACORD 75 Binder

Commercial Lines

ACORD 125

Business owners often require the Acord 125 form to apply for commercial insurance coverage, including general liability, property, and business auto.

ACORD FORM 125

Commercial Insurance

ACORD 126

Commercial businesses often need general liability insurance to protect against liability risks, including bodily injury or property damage claims.

ACORD FORM 126