Sample Certificate of Insurance (with Free Download)

By Sikander Mushtaq, Founder of VenueCOI · Updated October 1, 2026

Quick answer

A sample certificate of insurance shows what a real ACORD 25 looks like: producer, insured, insurers, a coverages grid with limits and dates, additional insured and subrogation columns, description of operations, and the certificate holder. Use the free sample below to see where each detail belongs and what a passing certificate should contain.

Key takeaways
  • A sample COI helps you spot exactly where limits, dates and additional insured wording appear.
  • The download below is a fictional ACORD 25-style sample for education only.
  • A good COI meets your limits, covers the event date, and names your venue as additional insured.
  • A bad COI has low or blank limits, expired dates, or lists you only as certificate holder.

Want to see what a certificate of insurance actually looks like before you ask vendors for one? Here's a free sample certificate of insurance in the standard ACORD 25 layout, plus a breakdown of what separates a good COI from a bad one.

Sample certificate of insurance in ACORD 25 layout showing producer, insured, insurers, a coverages grid with general liability, automobile, liquor liability and workers' compensation, limits, policy dates, additional insured and waiver of subrogation columns, description of operations and certificate holder
Sample certificate. Fictional companies, policy numbers and NAIC numbers. For education only.

Download the sample certificate (PDF) — a fictional ACORD 25-style COI you can use as a reference.

What's on the sample

The sample follows the standard ACORD 25 "Certificate of Liability Insurance" layout. Reading top to bottom:

SectionWhat it contains on the sample
ProducerThe agency that issued the certificate, with contact details
InsuredThe vendor's legal business name and address
Insurers A–FThe carriers, each with an NAIC number
Coverages gridGeneral liability, automobile, liquor liability, workers' comp
Limits$1M per occurrence / $2M aggregate on general liability
Policy datesEffective and expiration dates for each policy
ADDL INSD / SUBR WVDAdditional insured and waiver of subrogation flags
Description of OperationsNames the venue as additional insured for the event
Certificate HolderThe venue the certificate was sent to

For a full field-by-field walkthrough with numbered callouts, see how to read a certificate of insurance (ACORD 25).

Good COI vs bad COI

The same layout can pass or fail. Here's what to compare:

CheckGood COIBad COI
General liability limits$1M occurrence / $2M aggregate or higherBelow requirement, or blank
Policy datesCover the event dateExpire before the event
Additional insured"Y" + your venue named in Description of OperationsOnly listed as certificate holder
Liquor liability (bar/catering)Present where alcohol is servedMissing
Insured nameMatches the vendor you hiredA different or parent business
ProducerVerifiable agency with contact detailsNo contact details

What this means for your venue

Use the sample as your reference sheet. When a vendor's certificate comes in, put it next to the sample and check the same spots: are the limits high enough, do the dates cover the event, and is your venue named as additional insured in the description of operations — not just sitting in the certificate holder box?

Doing that comparison for one vendor takes a minute. Doing it for every vendor on every event, and chasing the ones that come back wrong, is what VenueCOI automates. You can also upload a real certificate to our free checker and see a pass/fail against a standard requirement instantly.

Frequently asked questions

Is this a real certificate of insurance?

No. It's a fictional sample for education only — the companies, policy numbers and NAIC numbers are made up. Use it to learn the layout, not as proof of anyone's coverage.

What form is a certificate of insurance?

In the US it's almost always the ACORD 25, titled 'Certificate of Liability Insurance.' Our sample follows that standard layout.

Can I use this sample to check a vendor's COI?

Use it as a reference for where each detail belongs. To check an actual vendor certificate against your requirements, upload it to our free COI checker.

What makes a certificate of insurance valid for my venue?

The limits meet your requirement, the policy dates cover your event date, and your venue is named as additional insured (not just certificate holder), with matching wording in the description of operations.

Stop reading COIs line by line

VenueCOI checks every vendor's certificate against your rules and chases the ones that aren't right. Your first event is free.

Related guides

This guide is general information, not legal or insurance advice. Requirements vary by state, venue and contract. Check with your insurance broker or attorney.

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