Contractor/Vendor/Performer: Give this form to your insurance agent/broker.
** Incomplete Certificates will not be accepted **

The 3rd Party Contractor/Vendor/Performer (“Insured”) performing duties/services/events or seeking to use facilities at La Sierra University (“Certificate Holder”) is required to carry the types and limits of insurance shown in this request, and to immediately provide Certificate Holder with a Certificate of Insurance. Certificate shall be executed by a duly authorized representative of each insurer, showing compliance with the insurance requirements set forth below.

All insurers shall have an “AM Best” rating (or equivalent) of A- or better and be licensed and admitted in California. All policies required shall be written as primary policies and not contributing to nor in excess of any coverage Certificate Holder may choose to maintain. 

Required Insurance Coverage - Insured shall obtain insurance of the types and in the amounts described below. (**)

• Commercial General Liability Insurance. Insured shall maintain commercial general liability (CGL) with a limit of not less than $1,000,000 each occurrence and $2,000,000 aggregate.
• Automobile Liability. If applicable, Insured shall maintain Automobile Liability in the amount of $1,000,000 Combined Single Limit (Coverage shall include Non-owned and Hired auto coverage). If applicable, Motor Truck Cargo Legal Liability Special Form, including Theft, with minimum limit of $100,000.
• Professional Liability. If applicable, Insured shall maintain Professional Liability (Errors & Omissions) insurance of not less than $1,000,000 on a “claims made” basis, to cover claims made during the policy period and reported within three years of the date of occurrence.
• Workers’ Compensation. Insured shall maintain all statutorily required Workers’ Compensation coverages to include Employer’s Liability at minimum limits $100,000/$500,000/$100,000
• Certificate Holder and Additional Insured Endorsement shall name the Board of Trustees of La Sierra University, a body corporate, and its officers, employees, agents, and volunteers LA SIERRA UNIVERSITY Attn: Risk Management 4500 Riverwalk Pkwy Riverside CA 92515
• All policies, except Workers’ Compensation, shall name Certificate Holder as an additional insured. A copy of the Additional Insured Endorsement must be attached to the Certificate verifying that the Insured’s policy(s) has been endorsed as required. (Otherwise the certificate will be considered incomplete)
• All certificates shall provide for thirty (30) days’ written notice to Certificate Holder prior to cancellation or material change of any insurance referred to in the certificate.

(** La Sierra University Risk Management reserves the right to modify coverage and/or limits.) 

Failure of Certificate Holder to demand a certificate or other evidence of full compliance with these insurance requirements or failure of Certificate Holder to identify a deficiency from evidence that is provided shall not be construed as a waiver of Insured’s obligation to maintain such insurance. Failure to maintain the required insurance may result in termination of the 3rd party contract/event at the Certificate Holder’s option. By requiring this insurance, Certificate Holder does not represent that coverage and limits will necessarily be adequate to protect Insured, and such coverage and limits shall not be deemed as a limitation on Insured’s liability.

Personal Property: Certificate Holder shall not be liable for any damage to or loss of Insured’s personal property.  Please direct any additional questions to:

09/2015 La Sierra University Risk Management www.lasierra.edu/risk Email: risk@lasierra.edu Fax 951.785.2095