Department of Labor and Regulation

<Title - Division of Insurance email the Division of Insurance

Certificates of Insurance

Unless otherwise specified, the forms below are provided in Adobe .pdf format*. Please note, in same cases, you may choose between Microsoft Excel format or Adobe .pdf format.

Certificate of Property Insurance — COPI-01-10  [Excel]  [Adobe .pdf]

Certificate of Liability Insurance - COLI-01-10  [Excel]  [Adobe .pdf]

View Bulletin 10-01.

Certificates of Insurance Notice

Certificate of Insurance Facts

The disclosure and cancellation language contained on Acord 24 (2009/09), Acord 25 (2009/09), and ISO Form IL C 001 09 03 is compliant with Bulletins 09-05 and 09-06.

Acord 24 (1/95) and Acord 25 (2009/01) that reflect an endorsement, amendment or reflect changes in the cancellation provision in the policy are not compliant with Bulletins 09-05 and 09-06. The following language must be placed in the description section of these forms:

"The cancellation portion of this certificate is left blank and no notice other than that provided by the policy is guaranteed, promised, or implied from the issuance of this certificate."

Bulletins 09-05 and 09-06 also apply to Evidence of Insurance for Personal Property and Commercial Property Coverages with similiar cancellation language.

Acord Forms - Certificate Changes

Please contact us with any questions regarding certificates of insurance.

Contact Us

Division of Insurance
SD Department of Labor and Regulation
445 East Capitol Avenue
Pierre, SD 57501
Phone: 605.773.3563
Fax: 605.773.5369

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Division of Insurance
124 S. Euclid Ave., 2nd Floor
Pierre, SD 57501
Tel. 605.773.3563
Fax. 605.773.5369