Sample Certificate of Insurance (COI) Guide

Show this guide to your insurance agent. Your policy MUST name VanHaulers Co. as ADDITIONAL INSURED & CERTIFICATE HOLDER.

⚠️ MANDATORY COI REQUIREMENTS

REQUIREMENT 1 MUST HAVE

1. NAMED AS ADDITIONAL INSURED

In the DESCRIPTION OF OPERATIONS / REMARKS box, your agent MUST explicitly state:

VANHAULERS CO IS NAMED AS ADDITIONAL INSURED.
SCHEDULED DRIVER: [Driver Full Legal Name]
RADIUS 500+ / Unlimited Radius of Operation

* Automobile Liability & Motor Truck Cargo must have the ADDL INSD box checked (X).

REQUIREMENT 2 MUST MATCH EXACTLY

2. CERTIFICATE HOLDER ADDRESS

The CERTIFICATE HOLDER box at the bottom left MUST state:

VANHAULERS CO
1215 HIGH ST
WILLIAMSPORT, PA 17701

* Cancellation notices (minimum 30 days) will be delivered to this Certificate Holder address.

Sample ACORD 25 Certificate Mockup

All names & numbers below are sample placeholders

ACORD CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY): 08/14/2026

PRODUCER (YOUR INSURANCE AGENCY): SAMPLE INSURANCE AGENCY INC 123 MAIN ST, SUITE 400 COLUMBUS, OH 43215 Agent: Jane Smith | Phone: (800) 555-0199 agent@sampleinsurance.com

INSURED (YOUR TRUCKING COMPANY): SAMPLE FREIGHT LOGISTICS LLC 100 ENTERPRISE WAY, SUITE 200 HOUSTON, TX 77001 NAIC #: 37923 (GEICO / Progressive / Commercial Provider)

Type of Insurance	ADDL INSD	Policy Number	Policy Eff	Policy Exp	Coverage Limits
AUTOMOBILE LIABILITY ☒ Scheduled Autos Only	X	9300XXXXXX-00	08/14/2026	08/14/2027	Combined Single Limit: $1,000,000
MOTOR TRUCK CARGO ☒ Cargo Endorsement	X	9300XXXXXX-00	08/14/2026	08/14/2027	Cargo Limit: $100,000 ($1,000 Deductible)

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101) ★ ADDITIONAL INSURED STATEMENT

VANHAULERS CO IS NAMED AS ADDITIONAL INSURED.
SCHEDULED DRIVER: [Driver Full Legal Name]
RADIUS 500+ / Unlimited Radius of Operation Applies
VEHICLE: 2024 Mercedes-Benz Sprinter (VIN: 1WTYXXXXXX)

CERTIFICATE HOLDER ★ CERTIFICATE HOLDER ADDRESS

VANHAULERS CO
1215 HIGH ST
WILLIAMSPORT, PA 17701

CANCELLATION:

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS (MINIMUM 30 DAYS WRITTEN NOTICE TO CERTIFICATE HOLDER).

AUTHORIZED REPRESENTATIVE SIGNATURE REQUIRED

📋 Copy & Paste Email Instructions for Your Insurance Agent

Send this exact text to your insurance broker

Hello Agent,

Please issue an ACORD 25 Certificate of Insurance for my policy with the following mandatory requirements:

1. ADDITIONAL INSURED WORDING (Description of Operations):

VANHAULERS CO IS NAMED AS ADDITIONAL INSURED.
SCHEDULED DRIVER: [Driver Full Legal Name]
RADIUS 500+ / Unlimited Radius of Operation
COMMERCIAL AUTO LIABILITY: $1,000,000 CSL
MOTOR TRUCK CARGO: $100,000 ($1,000 Deductible)

2. CERTIFICATE HOLDER:

VANHAULERS CO
1215 HIGH ST
WILLIAMSPORT, PA 17701

3. DIRECT SUBMISSION:
Please email the completed PDF certificate directly from your official insurance agency email domain to: recruit@vanhaulers.com

VANHAULERS CO. INTELLIGENCE & COMPLIANCE SYSTEM • COI SPECIFICATION GUIDE