Homepage / Fill in a Valid Insurance Policy Declaration Page Template
Jump Links

The Insurance Policy Declaration Page form serves as a vital document in establishing clear communication and understanding between a contractor and the city in relation to automobile insurance coverage. This form is particularly significant for contractors engaged by the City of San Diego. It outlines the obligations of the contractor concerning vehicle ownership and insurance requirements. Specifically, the form establishes that the contractor does not currently own any vehicles but must acquire and maintain automobile insurance for both “hired autos” and “non-owned autos” throughout the duration of the Agreement. Should the contractor acquire any vehicles during this time, immediate action is required to secure automobile insurance for “any auto.” Such specific coverage is essential, as it encompasses a range of scenarios involving vehicles used for business purposes, including those owned, hired, or borrowed. Defined terms within the form clarify the scope of coverage: “any auto” refers to all types of vehicles used, while “hired autos” and “non-owned autos” address specific circumstances surrounding vehicle usage and ownership. Accuracy in this declaration is crucial, as it ensures compliance with the insurance prerequisites set forth in the contractual Agreement.

Insurance Policy Declaration Page Example

DECLARATION OF CONTRACTOR RE: AUTOMOBILE INSURANCE COVERAGE

 

Regarding the Agreement between the City of San Diego, a municipal corporation [City]

and

, [Contractor]

Contractor declares as follows:

1.Contractor does not currently own any vehicles;

2.Contractor has obtained, and shall maintain during the term of the Agreement, automobile insurance coverage for “hired autos” and “non-owned autos”; and

3.In the event Contractor subsequently acquires any vehicle(s) during the term of the Agreement, the Contractor shall immediately obtain, and provide to the City the required evidence of, automobile insurance coverage for “any auto,” as required in Section 6.a of the Agreement.

For the purpose of this Declaration, automobile insurance coverage for “any auto,” “hired autos,” and “non-owned autos” are defined as follows:

Any Auto: Coverage is provided for any auto, including autos owned by the insured, autos the named insured hires or borrows from others, and other non-owned autos used in the insured's business.

Hired Autos: Coverage is provided only for autos leased, hired, rented, or borrowed for use in the named insured's business.

Non-owned Autos: Coverage is provided only for autos not owned, leased, hired, or borrowed by the named insured. Coverage includes autos owned by the insured's employees or members of their households, but only while used in the named insured's business or personal affairs.

Organization

Authorized Signer Name

Title

Signature

Date

Approved by

Victoria L. Hamilton, Commission for Arts and Culture

File Breakdown

Fact Name Fact Description
Type of Agreement This is a declaration regarding automobile insurance coverage between the City of San Diego and a contractor.
Current Vehicle Ownership The contractor declares that they do not currently own any vehicles.
Required Coverage The contractor must maintain automobile insurance coverage for "hired autos" and "non-owned autos" throughout the agreement's term.
Acquisition of Vehicles If the contractor acquires any vehicles during the contract term, they must obtain insurance for "any auto" immediately.
Definitions of Coverage The document defines "any auto," "hired autos," and "non-owned autos" distinctly, clarifying the scope of coverage.
Hired Autos Coverage This coverage applies only to vehicles leased, hired, rented, or borrowed for the contractor’s business use.
Non-owned Autos Coverage This insurance covers vehicles not owned, leased, hired, or borrowed by the contractor, including those owned by employees during business use.

Guide to Using Insurance Policy Declaration Page

To complete the Insurance Policy Declaration Page form, specific information needs to be provided clearly and accurately. After gathering the necessary details, follow these steps to fill out the form correctly.

  1. Begin by entering the name of the contractor in the designated space after “Contractor declares as follows:”
  2. Indicate whether the contractor currently owns any vehicles. If the answer is "no," write "does not currently own any vehicles." This is required for compliance.
  3. Provide information about the automobile insurance coverage for “hired autos” and “non-owned autos.” State that the contractor has obtained this insurance and will maintain it throughout the Agreement's term.
  4. Include a clause stating that if the contractor acquires any vehicle(s) during the Agreement, they will obtain the necessary automobile insurance coverage for “any auto” immediately.
  5. In the third point, reference the need to provide evidence of this insurance coverage to the City as required in Section 6.a of the Agreement.
  6. At the bottom of the form, fill out the organization’s authorized signer’s name and title.
  7. Sign and date the form. Make sure the date includes month, day, and year for clarity.
  8. Include approval by the designated authority, in this case, Victoria L. Hamilton, for the Commission for Arts and Culture.

Get Answers on Insurance Policy Declaration Page

What is the purpose of the Insurance Policy Declaration Page form?

The Insurance Policy Declaration Page form serves as a declaration by the contractor regarding their automobile insurance coverage. It is a critical component of the contractual agreement between the City of San Diego and the contractor. The form ensures that the contractor has appropriate insurance coverage to protect against liabilities that may arise during the execution of their business activities.

What information does the contractor need to provide on this form?

On this form, the contractor must provide the following information:

  1. A statement indicating whether they currently own any vehicles.
  2. A confirmation that they have secured automobile insurance coverage for "hired autos" and "non-owned autos."
  3. An agreement to obtain and provide evidence of insurance coverage for "any auto" if they acquire any vehicle during the term of the agreement.

What are the definitions of "Any Auto," "Hired Autos," and "Non-Owned Autos"?

Understanding these terms is crucial for compliance:

  • Any Auto: This coverage includes any auto owned by the insured, rented or borrowed vehicles, and non-owned vehicles used for business.
  • Hired Autos: This specific coverage applies to vehicles leased, hired, or rented solely for business purposes.
  • Non-Owned Autos: This covers vehicles not owned or leased by the insured, which may include personal vehicles used for business by employees or household members.

Why must the contractor provide evidence of insurance coverage?

Providing evidence of insurance coverage is essential for protecting both the contractor and the City of San Diego from potential liabilities. It ensures that the contractor bears responsibility for any damages or injuries resulting from the use of vehicles during their business operations. This requirement helps to mitigate risk for both parties involved in the agreement.

What happens if the contractor acquires a vehicle after signing the form?

If the contractor acquires any vehicles during the agreement's duration, they must immediately secure insurance coverage for "any auto" and provide the City with the necessary documentation. This prompt action ensures continued compliance with the insurance requirements set forth in the agreement.

Who approves the Insurance Policy Declaration Page form?

The form is approved by the designated authority, which, in this case, is Victoria L. Hamilton from the Commission for Arts and Culture. This approval signals that the contractor’s insurance declaration meets the required standards set by the City of San Diego.

What is the significance of the contractor's signature?

The contractor's signature on the form indicates their acknowledgment of the insurance requirements and their commitment to maintaining adequate coverage throughout the term of the agreement. It is a formal affirmation of their understanding and acceptance of the terms outlined in the declaration.

Common mistakes

Filling out the Insurance Policy Declaration Page form can seem straightforward, but many individuals make errors that can lead to complications. Awareness of these common mistakes is essential for ensuring compliance and protection. Here are seven frequent missteps.

1. Incomplete or Missing Information – One of the most significant errors is failing to provide all required details. Omitting essential information about the contractor’s name or signature can delay processing and create issues with coverage.

2. Non-Compliance with Insurance Coverage Requirements – Contractors may overlook the specific types of coverage required by the City. Confirming that “hired autos” and “non-owned autos” are included ensures compliance with the terms of the agreement.

3. Incorrect Definitions of Coverage – Some individuals might misunderstand what constitutes “any auto,” “hired autos,” and “non-owned autos.” Failing to grasp these definitions can lead to inadequate coverage for potential liabilities, making it crucial to review the definitions thoroughly.

4. Ignoring Future Vehicle Acquisitions – If a contractor plans to acquire vehicles during the contract period, they must understand the requirement to obtain insurance immediately. Ignoring this could lead to being uninsured at critical moments.

5. Neglecting to Provide Proof of Insurance – After acquiring insurance for “any auto,” it is vital to provide proof to the City. Failing to submit this evidence can create gaps in coverage and affect contract validity.

6. Inaccurate Signatures or Dates – Errors in signing the document or dating it incorrectly can result in administrative issues. Ensuring that the organization’s authorized signer completes this section correctly can prevent unnecessary delays.

7. Overlooking Approval Process – Even after completing the declaration, some rush through without confirming approval. It is critical to ensure that the form is reviewed and approved by the appropriate authority to avoid disputes later.

Being mindful of these errors can mitigate risks and facilitate a smoother process for all parties involved. It’s advisable to double-check the form prior to submission to ensure it meets all requirements.

Documents used along the form

The Insurance Policy Declaration Page form serves as a crucial document that outlines the insurance coverage details between the contractor and the City of San Diego. Along with this form, several other documents may be utilized to ensure a comprehensive understanding of insurance obligations and protection. Here are some common forms and documents that are often used in conjunction with the Insurance Policy Declaration Page:

  • Certificate of Insurance: This document provides proof of insurance coverage. It typically summarizes the types of coverage the insured has, limits, and the policy effective dates. It's often required by clients or partners as a condition for doing business.
  • Insurance Policy: The full insurance policy contains all the terms, conditions, and coverages granted by the insurance company. This document is essential for understanding the specific protections and obligations under the policy.
  • Additional Insured Endorsement: This endorsement expands an insurance policy to cover additional parties as "insured." It can offer protection to clients or property owners when using someone else's services or property.
  • Waiver of Subrogation: This document prevents the insurance company from seeking reimbursement from a third party for a loss. It can be crucial in protecting relationships between contractors and clients in case of a claim.
  • Proof of Coverage Notice: This notice informs involved parties that insurance coverage is in place and describes the applicable coverage terms. It's often required before agreements can proceed.
  • Claim Form: In the event of a loss or incident, this form is used to report the claim to the insurance company. It typically includes details about the event, damages, and parties involved.

Understanding these documents alongside the Insurance Policy Declaration Page can help ensure that all parties are aware of their rights, obligations, and protections under the agreement. It’s crucial to keep everything organized and accessible to avoid any complications as the contract progresses.

Similar forms

  • Insurance Policy Summary: Similar to the Declaration Page, the policy summary provides a brief overview of the insurance coverage, including key details such as the types of coverage, limits, and deductibles. It serves as an easy reference for policyholders to understand their insurance protections.
  • Certificate of Insurance: This document confirms insurance coverage for a specific entity or individual. Like the Declaration Page, it outlines the coverage types and serves as proof of insurance, often required by third parties or in contractual agreements.
  • Endorsement Document: Endorsements modify or add terms to the existing insurance policy. While the Declaration Page specifies coverage details, an endorsement can change certain aspects, such as adding new types of coverage or altering existing limits.
  • Coverage Rider: This document is used to add or change coverage on an existing insurance policy. Similar to the Declaration Page, it offers specific details about additional protections that may not be included in the initial policy.
  • Claims Evidence Form: This form documents any claims made under an insurance policy. While it serves a different purpose, it reflects the ongoing relationship between the policyholder and the insurer, detailing events that necessitate the insurance coverage highlighted in the Declaration Page.
  • Terms and Conditions Document: This is a comprehensive outline of all the terms governing the insurance policy. Like the Declaration Page, it ensures that both the insured and the insurer understand their rights and obligations under the policy.

Dos and Don'ts

When filling out the Insurance Policy Declaration Page form, it is essential to be aware of the following guidelines. These tips can help ensure that the process is smooth and all necessary information is provided correctly.

  • Always fill in the complete name of the Contractor to avoid any confusion.
  • Provide accurate details about whether the Contractor currently owns any vehicles.
  • Ensure that the Contractor has obtained and maintains proper automobile insurance coverage as specified.
  • Immediately update the City if any vehicles are acquired during the term of the Agreement.
  • Attach evidence of automobile insurance coverage without delay once a new vehicle is acquired.

Conversely, there are certain actions to avoid while completing the form. These missteps can lead to complications or delays.

  • Do not skip any required fields on the form, as this may lead to processing issues.
  • Avoid using vague language or unclear descriptions regarding the insurance coverage.
  • Do not forget to sign and date the form, as an unsigned document may be invalid.
  • Never provide false or misleading information, as this can have serious repercussions.

Misconceptions

Understanding the Insurance Policy Declaration Page is essential for contractors working with municipal corporations. However, several misconceptions can cloud this important document. Here are five common misconceptions:

  • All vehicles are always covered under the policy. Many people believe that the insurance covers any vehicle as long as it is listed on the declaration page. In reality, the coverage depends on the specific definitions of "any auto," "hired autos," and "non-owned autos." Each category has its own limitations.
  • Non-owned autos are fully covered. There's a misconception that non-owned auto coverage offers the same protection as owned vehicles. Instead, it only applies to vehicles not owned, leased, hired, or borrowed by the insured, and it primarily protects vehicles used for business purposes.
  • The contractor's personal vehicles are automatically included. Many assume that personal vehicles are shielded under the business policy just because they work for a contractor. However, coverage typically does not extend to personal vehicles unless they are utilized for business purposes.
  • Hired autos cover every borrowed vehicle. Individuals often think that any borrowed vehicle qualifies for hired auto coverage. This is incorrect since it only applies to vehicles specifically leased, rented, or borrowed for business use.
  • Updating vehicle ownership with the city is optional. Some contractors might believe that informing the city of newly acquired vehicles is not necessary. In fact, it is mandatory to obtain and present proof of insurance for any new vehicles acquired during the agreement's term.

Key takeaways

When filling out the Insurance Policy Declaration Page form for automobile insurance coverage, the following key takeaways should be kept in mind:

  • Understand Coverage Types: Familiarize yourself with the definitions of "any auto," "hired autos," and "non-owned autos" to ensure you select the appropriate coverage for your needs.
  • Keep Evidence Updated: If you acquire any vehicles during the term of the Agreement, obtain and promptly provide the required proof of insurance coverage for “any auto.”
  • Maintain Continuous Coverage: Ensure that you have maintained automobile insurance for “hired autos” and “non-owned autos” throughout the duration of the Agreement.
  • Signature Requirement: Remember that this document must be signed by the authorized signer of the organization to validate the Declaration.