Section 12-3-2.1-0-00650 - CERTIFICATE OF INSURANCE INSTRUCTIONS1. The Certificate of Insurance is a tabulation of insurance required for this Project as specified in Article 11 entitled Insurance and Bonds in the General Conditions (AIA Document A201, Sixteenth Edition, 2007).2. The Certificate of Insurance must be completed, certified by the original signature of a Mississippi Licensed Insurance Agent and/or countersignature, dated, and bound in each set of the Contract Documents. Insurance Companies providing coverage and Agent and/or Countersignature Agent must be approved by the Mississippi Insurance Department on their web at http://www.mid.ms.gov/licapp/search_main.aspx. (Agent does not have to be on the MID web "for providers necessarily" but must be an approved Agent on MID web. Easier to locate Agent at MID when name agrees with MID licensed name.)3. Indicate Insured, Project, Companies providing coverage, policy numbers and policy periods in the blanks as applicable.4. If the "OWNERS/CONTRACTORS PROTECTIVE LIABILITY" insurance is part of the Commercial General Liability Insurance Policy, or included by endorsement, indicate the policy number and period of the CGL policy in the "OWNERS/CONTRACTORS PROTECTIVE LIABILITY" blank spaces.5. Automobile Liability Insurance may be provided which covers Bodily Injury and Property Damage in one (1) Combined Single Limit, or may be provided with separate minimum limits as shown on the Certificate of Insurance and specified in Article 11 of the Supplementary Conditions. The person signing the Certificate of Insurance should show which option the Contractor has selected by marking out the coverage that is not provided under the policies indicated.6. OTHER INSURANCE (if required) will be indicated by typing in the "OTHER" block and detailed in Article 11 of the Supplementary Conditions.7. CERTIFICATION wording may not be changed without specific written approval from the Owner.8. "Riders", Binders, TBA, TBD, or other unsolicited attachments, are not allowed as part of the Certificate of Insurance unless specifically requested in writing by the Owner, or specified as part of the requirements for this Project.9. CAUTION: The Certificate of Insurance is intended to be used for all Projects. The Contractor must provide all insurance specified in the Contract Documents for this Project, whether indicated on this form, or not. The Contractor must verify all insurance has been provided as required.10. In accepting the Insurance Certificate by Owner, it would be helpful if some indication is given when, and if, the Provider is a Surplus Line Carrier, a Broker, or Self Insured (because they may not be on the MID web list referenced herein). (The Owner will have to ask MID (or know) at some point.)12 Miss. Code. R. 3-2.1-0-00650