Certificate of Insurance Request Template

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Willow Creek Estates Homeowners Association, Inc.

Contract WC-LS-2025-001

May 5, 2025

Certificate of Insurance Request

DateMay 5, 2025

Contract #WC-LS-2025-001

Response DeadlineMay 19, 2025

From

Willow Creek Estates Homeowners Association, Inc.

Jamie Tran, Treasurer

To

GreenLeaf Landscape Co.

Attn: Devon Chen, Account Manager

4100 Industrial Oaks Blvd, Austin, TX 78735

Re: 12-month landscape maintenance services for common areas (Contract #WC-LS-2025-001)

Before commencing work or services on Association property, please provide a Certificate of Insurance (ACORD 25 or another certificate form approved for use in your state) evidencing the following coverages, in amounts not less than the limits stated:

Required Coverage

Coverage

Limit

Basis

Commercial General Liability

$1,000,000

each occurrence / $2,000,000 general aggregate

Automobile Liability (any auto)

$1,000,000

combined single limit

Workers' Compensation

Statutory

as required by state law

Employer's Liability

$1,000,000

each accident / each employee (disease) / policy limit (disease)

Umbrella / Excess Liability

$2,000,000

each occurrence / aggregate, following form

Additional Insured and Endorsements

As required by the Contract, Willow Creek Estates Homeowners Association, Inc., its officers, directors, employees and agents must be additional insureds under the Commercial General Liability (ongoing and completed operations), Automobile Liability and Umbrella/Excess policies, on a primary and non-contributory basis, to the extent permitted by applicable law. Each of those policies, and the Workers' Compensation / Employer's Liability policy, must include a waiver of subrogation in favor of the Association.

Please attach copies of the endorsements that provide this coverage (for example ISO CG 20 10 and CG 20 37 or CG 20 26, CG 20 01, CG 24 04, and WC 00 03 13, or their equivalents). The Certificate should identify those endorsements; it does not replace them.

Suggested Description of Operations: "Contract No. WC-LS-2025-001, landscape maintenance of common areas. Certificate holder is an additional insured as provided in the attached endorsements."

Certificate Holder and Ongoing Requirements

Show the Certificate Holder as: Willow Creek Estates Homeowners Association, Inc., PO Box 7842, Austin, TX 78758. Coverage must be maintained for the full term of the contract and, for completed operations, for 2 years after the work is completed. Please send a renewal certificate before any required policy expires, and notify the Association promptly in writing if any required policy is cancelled or its limits are reduced. Insurers must be rated at least A- VII by A.M. Best unless the Association agrees otherwise in writing.

Response Deadline

Please provide the Certificate of Insurance and endorsements on or before May 19, 2025. Work may not commence until a compliant Certificate is on file with the Association.

Send them to PO Box 7842, Austin, TX 78758 or email insurance+willowcreek@propper.ai.

Thank you,

Requested by

Jamie Tran

Treasurer, Willow Creek Estates Homeowners Association, Inc.