Section Name
Field Name
Field and/or Section Description
TITLE
ACORD 23 (2010/05)
Vehicle or Equipment Certificate of
Insurance
ACORD 23, Vehicle or Equipment Certificate of Insurance, is used to
provide a coverage statement with respect to physical damage, property, and/or liability
insurance coverage to the additional interest(s) of leased or financed vehicles or
equipment, but only when the insurance policy covering the subject vehicle or equipment
includes an endorsement or policy condition stating that the insurer will notify the
additional interest(s) in the event of policy termination.
Please note the following concerning the use of this Certificate:
1.Vehicle(s) may be defined as motor-vehicles, highway vehicles, non-highway vehicles,
on-road vehicles, and/or off-road vehicles.
2.Vehicle(s) may (or may not) be subject to State-Specific Department of Motor Vehicle
Regulations, Financial Responsibility Laws and/or Department of Insurance Regulations.
3.Please review your local State Department of Motor Vehicles and/or State Department
of Insurance Regulations for specific definitions and requirements.
For all other situations requiring certification of property or liability insurance or evidence of
property insurance, use ACORD 24, Certificate of Property Insurance; ACORD 25,
Certificate of Liability Insurance; ACORD 27, Evidence of Property Insurance, or ACORD
28, Evidence of Commercial Property Insurance.
TITLE
IMPORTANT
Iowa, Kansas, Kentucky, Louisiana, Minnesota, Missouri, North Carolina, North Dakota,
Oklahoma, Utah and Wisconsin require the filing of certificate of insurance forms. ACORD
has filed all of its certificates in these states. In these states, the text of ACORD's
certificates cannot be modified, unless the modified form is filed for approval by the
respective state Department of Insurance.
Additionally, virtually every other state will not allow any change in a certificate of
insurance that would attempt to modify a policy unless the revised certificate is filed and
approved. In these states, this form can only be changed to reflect the terms and
conditions of the policy on which it is reporting. Such change(s) must be approved in
advance by the insurance carrier that issued such policy.
ACORD 23 (2010/05) rev. 04-22-2011
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Section Name
Field Name
Field and/or Section Description
IDENTIFICATION SECTION
Date
Enter date: The month/day/year on which the form is completed. (MM/DD/YYYY)
IDENTIFICATION SECTION
Producer
Enter text: The full name of the producer/agency.
IDENTIFICATION SECTION
Address 1
Enter text: The mailing address line one of the producer/agency.
IDENTIFICATION SECTION
Address 2
Enter text: The mailing address line two of the producer/agency.
IDENTIFICATION SECTION
City
Enter text: The mailing address city name of the producer/agency.
IDENTIFICATION SECTION
State
Enter code: The mailing address state or province code of the producer/agency.
IDENTIFICATION SECTION
Zip
Enter code: The mailing address postal code of the producer/agency.
IDENTIFICATION SECTION
Insured
Enter text: The named insured(s) as it/they will appear on the policy declarations page.
IDENTIFICATION SECTION
Address 1
Enter text: The named insured's mailing address line one.
IDENTIFICATION SECTION
Address 2
Enter text: The named insured's mailing address line two.
IDENTIFICATION SECTION
City
Enter text: The named insured's mailing address city name.
IDENTIFICATION SECTION
State
Enter code: The named insured's mailing address state or province code.
IDENTIFICATION SECTION
Zip
Enter code: The named insured's mailing address postal code.
IDENTIFICATION SECTION
Contact Name
Enter text: The name of the individual at the producer's establishment that is the primary
contact.
IDENTIFICATION SECTION
Phone (A/C, No, Ext)
Enter number: The producer's contact person's phone number. If applicable, include the
area code and extension.
IDENTIFICATION SECTION
FAX
Enter number: The fax number of the producer/agency.
IDENTIFICATION SECTION
E-Mail Address
Enter text: The producer's contact person e-mail address.
IDENTIFICATION SECTION
Producer Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g.
agency or brokerage).
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Section Name
Field Name
Field and/or Section Description
INSURER(S) AFFORDING
COVERAGE
Company A
Enter text: The insurer's full legal company name(s) as found in the file copy of the policy.
Use the actual name of the company within the group to which the policy has been issued.
This is not the insurer's group name or trade name.
INSURER(S) AFFORDING
COVERAGE
NAIC #
Enter code: The identification code assigned to the insurer by the NAIC.
INSURER(S) AFFORDING
COVERAGE
Company B
Enter text: The insurer's full legal company name(s) as found in the file copy of the policy.
Use the actual name of the company within the group to which the policy has been issued.
This is not the insurer's group name or trade name.
INSURER(S) AFFORDING
COVERAGE
NAIC #
Enter code: The identification code assigned to the insurer by the NAIC.
INSURER(S) AFFORDING
COVERAGE
Company C
Enter text: The insurer's full legal company name(s) as found in the file copy of the policy.
Use the actual name of the company within the group to which the policy has been issued.
This is not the insurer's group name or trade name.
INSURER(S) AFFORDING
COVERAGE
NAIC #
Enter code: The identification code assigned to the insurer by the NAIC.
INSURER(S) AFFORDING
COVERAGE
Company D
Enter text: The insurer's full legal company name(s) as found in the file copy of the policy.
Use the actual name of the company within the group to which the policy has been issued.
This is not the insurer's group name or trade name.
INSURER(S) AFFORDING
COVERAGE
NAIC #
Enter code: The identification code assigned to the insurer by the NAIC.
INSURER(S) AFFORDING
COVERAGE
Company E
Enter text: The insurer's full legal company name(s) as found in the file copy of the policy.
Use the actual name of the company within the group to which the policy has been issued.
This is not the insurer's group name or trade name.
INSURER(S) AFFORDING
COVERAGE
NAIC #
Enter code: The identification code assigned to the insurer by the NAIC.
DESCRIPTION OF VEHICLE
OR EQUIPMENT
Year
Enter year: The model year of the vehicle.
DESCRIPTION OF VEHICLE
OR EQUIPMENT
Make / Manufacturer
Enter text: The manufacturer of the vehicle (e.g. Ford, Chevy).
DESCRIPTION OF VEHICLE
OR EQUIPMENT
Model
Enter text: The manufacturer's model name for the vehicle.
DESCRIPTION OF VEHICLE
OR EQUIPMENT
Body Type
Enter code: The body type of the vehicle.
DESCRIPTION OF VEHICLE
OR EQUIPMENT
VIN
Enter identifier: The equipment identification number (VIN) assigned by the manufacturer.
ACORD 23 (2010/05) rev. 04-22-2011
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Section Name
Field Name
Field and/or Section Description
DESCRIPTION OF VEHICLE
OR EQUIPMENT
Description
Enter text: The description of the equipment.
COVERAGES
Serial Number
Enter identifier: The serial number for the equipment.
IDENTIFICATION SECTION
Certificate Number
Enter identifier: The insurer assigned number for the certificate.
COVERAGES
Revision Number
Enter number: The producer assigned revision number for the certificate.
COVERAGES
Insr Ltr
Enter code: The Company Letter of the insurer, as identified in the Insurer(s) Affording
Coverage form section, associated with the policy. As used here, this is the insurer letter
for the policy providing vehicle liability coverage.
COVERAGES
Add'l Insrd
Enter Y for a Yes response. Input N for No response. Indicates if the certificate holder
has been named as an additional insured on the policy.
COVERAGES
Vehicle Liability
Check the box (if applicable): Indicates the vehicle has liability coverage.
COVERAGES
Policy Number
Enter identifier: The identifier assigned by the insurer to the policy, or submission, being
referenced exactly as it appears on the policy, including prefix and suffix symbols. If
required for self-insurance, the self-insured license or contract number.
COVERAGES
Policy Effective Date
Enter date: The effective date of the policy. The date that the terms and conditions of the
policy commence.
COVERAGES
Policy Expiration Date
Enter date: The date on which the terms and conditions of the policy will expire.
COVERAGES
Limits Combined Single Limit $
Enter limit: The vehicle combined single limit liability each accident amount. Any questions
about appropriate limits or applicable policy coverage(s) should be answered by the
issuing insurer(s).
COVERAGES
Bodily Injury (Per Person) $
Enter limit: The vehicle policy, bodily injury per person limit amount. Any questions about
appropriate limits or applicable policy coverage(s) should be answered by the issuing
insurer(s).
COVERAGES
Bodily Injury (Per Accident) $
Enter limit: The vehicle policy, bodily injury per accident limit amount. Any questions about
appropriate limits or applicable policy coverage(s) should be answered by the issuing
insurer(s).
COVERAGES
Property Damage
Enter limit: The vehicle policy, property damage per accident limit amount. Any questions
about appropriate limits or applicable policy coverage(s) should be answered by the
issuing insurer(s).
COVERAGES
Insr Ltr
Enter code: The Company Letter of the insurer, as identified in the Insurer(s) Affording
Coverage form section, associated with the policy. As used here, this is the insurer letter
for the policy providing general liability coverage.
COVERAGES
Add'l Insrd
Enter Y for a Yes response. Input N for No response. Indicates if the certificate holder
has been named as an additional insured on the policy.
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Section Name
Field Name
Field and/or Section Description
COVERAGES
Occurrence
Check the box (if applicable): Indicates the general liability policy, occurrence basis
applies.
COVERAGES
Claims Made
Check the box (if applicable): Indicates the claims made option applies on the general
liability policy.
COVERAGES
Policy Number
Enter identifier: The identifier assigned by the insurer to the policy, or submission, being
referenced exactly as it appears on the policy, including prefix and suffix symbols. If
required for self-insurance, the self-insured license or contract number.
COVERAGES
Policy Effective Date
Enter date: The effective date of the policy. The date that the terms and conditions of the
policy commence.
COVERAGES
Policy Expiration Date
Enter date: The date on which the terms and conditions of the policy will expire.
COVERAGES
Each Occurrence
Enter limit: The general liability, each occurrence limit amount. Any questions about
appropriate limits or applicable policy coverage(s) should be answered by the issuing
insurer(s).
COVERAGES
General Aggregate
Enter limit: The general liability, general aggregate limit amount. Any questions about
appropriate limits or applicable policy coverage(s) should be answered by the issuing
insurer(s).
COVERAGES
Other Limit Description
Enter text: The description of other coverage (not the limit) on the vehicle policy. Any
questions about appropriate limits or applicable policy coverage(s) should be answered by
the issuing insurer(s).
COVERAGES
Limit
Enter limit: The general liability, other coverage limit amount. Any questions about
appropriate limits or applicable policy coverage(s) should be answered by the issuing
insurer(s).
COVERAGES
Insr Ltr
Enter code: The Company Letter of the insurer, as identified in the Insurer(s) Affording
Coverage form section, associated with the policy. As used here, this is the insurer letter
for the policy providing vehicle collision loss coverage.
COVERAGES
Loss Payee
Enter Y for a Yes response. Input N for No response. Indicates if the certificate holder
has been named as loss payee on the policy.
COVERAGES
Veh Collision Loss
Check the box (if applicable): Indicates the vehicle has collision coverage.
COVERAGES
Other
Check the box (if applicable): Indicates the vehicle has a type of coverage not specifically
listed.
COVERAGES
Other Description
Enter text: The description of the other type of coverage on the vehicle.
COVERAGES
Policy Number
Enter identifier: The identifier assigned by the insurer to the policy, or submission, being
referenced exactly as it appears on the policy, including prefix and suffix symbols. If
required for self-insurance, the self-insured license or contract number.
COVERAGES
Policy Effective Date
Enter date: The effective date of the policy. The date that the terms and conditions of the
policy commence.
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Section Name
Field Name
Field and/or Section Description
COVERAGES
Policy Expiration Date
Enter date: The date on which the terms and conditions of the policy will expire.
COVERAGES
ACV
Check the box (if applicable): Indicates the valuation method used in determining the value
of the vehicle or equipment at the time of loss is the actual cash value or market value.
COVERAGES
Other Limit
Check the box (if applicable): Indicates the valuation method used in determining the value
of the vehicle or equipment at the time of loss is other than those listed.
COVERAGES
Other Limit Description
Enter text: The valuation method used in determining the value of the vehicle or equipment
at the time of loss.
COVERAGES
Agreed Amount
Check the box (if applicable): Indicates the valuation method used in determining the value
of the vehicle or equipment at the time of loss is the agreed amount.
COVERAGES
Stated Amount
Check the box (if applicable): Indicates the valuation method used in determining the value
of the vehicle or equipment at the time of loss is the stated amount.
COVERAGES
Limit Amount
Enter limit: The limit associated with collision coverage.
COVERAGES
Deductible Amount
Enter deductible: The collision deductible amount.
COVERAGES
Insr Ltr
Enter code: The Company Letter of the insurer, as identified in the Insurer(s) Affording
Coverage form section, associated with the policy. As used here, this is the insurer letter
for the policy providing vehicle comprehensive or other than collision loss coverage.
COVERAGES
Loss Payee
Enter Y for a Yes response. Input N for No response. Indicates if the certificate holder
has been named as loss payee on the policy.
COVERAGES
Veh Comp
Check the box (if applicable): Indicates the vehicle has comprehensive or other than
collision coverage. As used here, indicates the vehicle has comprehensive coverage.
COVERAGES
Other
Check the box (if applicable): Indicates the vehicle has a type of coverage not specifically
listed.
COVERAGES
Other Description
Enter text: The description of the other type of coverage on the vehicle.
COVERAGES
Veh OTC
Check the box (if applicable): Indicates the vehicle has comprehensive or other than
collision coverage. As used here, indicates the vehicle has other than collision coverage.
COVERAGES
Policy Number
Enter identifier: The identifier assigned by the insurer to the policy, or submission, being
referenced exactly as it appears on the policy, including prefix and suffix symbols. If
required for self-insurance, the self-insured license or contract number.
COVERAGES
Policy Effective Date
Enter date: The effective date of the policy. The date that the terms and conditions of the
policy commence.
COVERAGES
Policy Expiration Date
Enter date: The date on which the terms and conditions of the policy will expire.
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Section Name
Field Name
Field and/or Section Description
COVERAGES
ACV
Check the box (if applicable): Indicates the valuation method used in determining the value
of the vehicle or equipment at the time of loss is the actual cash value or market value.
COVERAGES
Other Limit
Check the box (if applicable): Indicates the valuation method used in determining the value
of the vehicle or equipment at the time of loss is other than those listed.
COVERAGES
Other Limit Description
Enter text: The valuation method used in determining the value of the vehicle or equipment
at the time of loss.
COVERAGES
Agreed Amount
Check the box (if applicable): Indicates the valuation method used in determining the value
of the vehicle or equipment at the time of loss is the agreed amount.
COVERAGES
Stated Amount
Check the box (if applicable): Indicates the valuation method used in determining the value
of the vehicle or equipment at the time of loss is the stated amount.
COVERAGES
Limit Amount
Enter limit: The limit associated with comprehensive coverage. In Texas this is the
comprehensive limit only.
COVERAGES
Deductible Amount
Enter deductible: The comprehensive or other than collision deductible amount.
COVERAGES
Insr Ltr
Enter code: The Company Letter of the insurer, as identified in the Insurer(s) Affording
Coverage form section, associated with the policy. As used here, this is the insurer letter
for the policy providing property loss coverage.
COVERAGES
Loss Payee
Enter Y for a Yes response. Input N for No response. Indicates if the certificate holder
has been named as loss payee on the policy.
COVERAGES
Basic
Check the box (if applicable): Indicates the cause of loss for the subject of insurance is
basic.
COVERAGES
Special
Check the box (if applicable): Indicates the cause of loss for the subject of insurance is
special.
COVERAGES
Broad
Check the box (if applicable): Indicates the cause of loss for the subject of insurance is
broad.
COVERAGES
Other
Check the box (if applicable): Indicates the cause of loss for the subject of insurance is
other than those listed.
COVERAGES
Other Description
Enter text: The cause of loss for the subject of insurance.
COVERAGES
Policy Number
Enter identifier: The identifier assigned by the insurer to the policy, or submission, being
referenced exactly as it appears on the policy, including prefix and suffix symbols. If
required for self-insurance, the self-insured license or contract number.
COVERAGES
Policy Effective Date
Enter date: The effective date of the policy. The date that the terms and conditions of the
policy commence.
COVERAGES
Policy Expiration Date
Enter date: The date on which the terms and conditions of the policy will expire.
ACORD 23 (2010/05) rev. 04-22-2011
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Section Name
Field Name
Field and/or Section Description
COVERAGES
ACV
Check the box (if applicable): Indicates the valuation method used in determining the value
of the vehicle or equipment at the time of loss is the actual cash value or market value.
COVERAGES
RC
Check the box (if applicable): Indicates the valuation used in determining the limit of
insurance is replacement cost.
COVERAGES
Other Limit
Check the box (if applicable): Indicates the valuation method used in determining the value
of the vehicle or equipment at the time of loss is other than those listed.
COVERAGES
Other Limit Description
Enter text: The valuation method used in determining the value of the vehicle or equipment
at the time of loss.
COVERAGES
Agreed Amount
Check the box (if applicable): Indicates the valuation method used in determining the value
of the vehicle or equipment at the time of loss is the agreed amount.
COVERAGES
Stated Amount
Check the box (if applicable): Indicates the valuation method used in determining the value
of the vehicle or equipment at the time of loss is the stated amount.
COVERAGES
Limit Amount
Enter limit: The limit associated with comprehensive coverage. In Texas this is the
comprehensive limit only.
COVERAGES
Deductible Amount
Enter deductible: The deductible amount of the coverage.
COVERAGES
Insr Ltr
Enter code: The Company Letter of the insurer, as identified in the Insurer(s) Affording
Coverage form section, associated with the policy. As used here, this is the insurer letter
for the policy providing coverage that is not pre-printed on the form.
COVERAGES
Loss Payee
Enter Y for a Yes response. Input N for No response. Indicates if the certificate holder
has been named as loss payee on the policy.
COVERAGES
Other
Check the box (if applicable): Indicates the vehicle has a type of coverage not specifically
listed. As used here, indicates the vehicle or equipment has a type of coverage not
specifically listed.
COVERAGES
Other Description
Enter text: The description of the other type of coverage on the vehicle.
COVERAGES
Policy Number
Enter identifier: The identifier assigned by the insurer to the policy, or submission, being
referenced exactly as it appears on the policy, including prefix and suffix symbols. If
required for self-insurance, the self-insured license or contract number.
COVERAGES
Policy Effective Date
Enter date: The effective date of the policy. The date that the terms and conditions of the
policy commence.
COVERAGES
Policy Expiration Date
Enter date: The date on which the terms and conditions of the policy will expire.
COVERAGES
Limit Amount
Enter limit: The limit amount of the other coverage.
COVERAGES
Deductible Amount
Enter deductible: The deductible amount of the coverage.
COVERAGES
Remarks
Enter text: The Certificate Of Liability Insurance general remarks. The additional
comments or special conditions that may exist upon the policy. ACORD 101, Additional
Remarks Schedule, may be attached if more space is required.
ACORD 23 (2010/05) rev. 04-22-2011
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Section Name
Field Name
Field and/or Section Description
ADDITIONAL INTEREST
The additional interest(s)
described below has been added
to the policy(ies) listed herein by
policy number(s).
Check the box (if applicable): Indicates the additional interest has been added or named to
the policy.
ADDITIONAL INTEREST
A request has been submitted to
add the additional interest(s)
described below to the policy(ies)
listed herein by policy number(s).
Check the box (if applicable): Indicates a request to add the additional insured to the
policy.
ADDITIONAL INTEREST
Leased (check box)
Check the box (if applicable): Indicates the vehicle is leased.
ADDITIONAL INTEREST
Financed (check box)
Check the box (if applicable): Indicates the vehicle is financed.
ADDITIONAL INTEREST
Name and Address of Additional
Interest
Enter text: The certificate holder's full name.
ADDITIONAL INTEREST
Address 1
Enter text: The certificate holder's mailing address line one.
ADDITIONAL INTEREST
Address 2
Enter text: The certificate holder's mailing address line two.
ADDITIONAL INTEREST
City
Enter text: The certificate holder's mailing address city name.
ADDITIONAL INTEREST
State
Enter code: The certificate holder's mailing address state or province code.
ADDITIONAL INTEREST
Zip
Enter code: The certificate holder's mailing address postal code.
ADDITIONAL INTEREST
Additional Insured
Check the box (if applicable): Indicates the additional interest type is an additional insured.
ADDITIONAL INTEREST
Lender's Loss Payee
Check the box (if applicable): Indicates the additional interest type is a lenders loss
payable.
ADDITIONAL INTEREST
Loss Payee
Check the box (if applicable): Indicates the additional interest type is a loss payee.
ADDITIONAL INTEREST
Other Additional Interest
Check the box (if applicable): Indicates the additional interest is not any of the types listed
on the form.
ADDITIONAL INTEREST
Other Additional Interest
Description
Enter text: The description of the type of interest in the item.
ADDITIONAL INTEREST
Loan / Lease Number
Enter identifier: The loan number, account number or other controlling number that the
additional interest may have assigned the insured.
ADDITIONAL INTEREST
Authorized Representative
Sign here: Accommodates the signature of the authorized representative (e.g. producer,
agent, broker, etc.) by all companies to issue Certificates. This is required in most states.
Edition
Date
The edition identifier of the form including the form number and edition (the date is typically
formatted YYYY/MM).
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