Printable form

Certificate of insurance request letter

Pick a harbor and this writes the request to your insurance broker: a certificate with the harbor as certificate holder, the additional-insured endorsement with the harbor's exact wording, and its published limits. Copy it, email it, or print it.

By the DockDash teamLast reviewed November 11, 2026How we research

The harbor

Harbor or marina

Harbors listed here publish insurance requirements. The wording fills in below; you can edit it.

Harbor name in the letter

General liability per occurrence

USD

General liability aggregate

USD

Certificate holder (exactly as the harbor gives it)

Additional insured wording (exactly as the harbor gives it)

Other insurance requirements (one per line)

Wording from: Brickyard Cove Marina, Approved Contractor Form. Checked Nov 11, 2026.

Also ask for Additional insured on the auto policy too A workers' comp certificate Waiver of subrogation Primary and non-contributory wording Notice of cancellation to the holder

Your business

Business name

Your name

Phone

Work you'll do at the harbor

Be specific: e.g. in-water hull cleaning and zinc replacement; no hot work.

Your broker

Broker name

Agency

Broker email

Needed by (optional)

Business and broker details are remembered in this browser only. Nothing is sent.

Your letter

[date]

To: [broker name]

Re: Certificate of insurance and additional-insured endorsement for Brickyard Cove Marina (Point Richmond)

Hello,

[business name] needs a certificate of insurance for Brickyard Cove Marina (Point Richmond) so we can work there. Our work at the harbor: [describe your work].

Please issue:

1. A certificate of insurance showing the certificate holder exactly as: [certificate holder name and address, as the harbor gives it]
2. The additional-insured endorsement page (not only a note on the certificate) naming exactly: Brickyard Cove Marina
3. General liability limits of at least $1,000,000 per occurrence, as the harbor requires.
4. Coverage for the harbor's other published requirements:
   - Proof of current workers' compensation

If anything above isn't covered by our current policies, please tell me what it would take to add it.

Thank you,
[your name]
[business name]

Open in my email app

How this works

Harbors usually want two things from your broker: a certificate of insurance (often the ACORD 25 form), which the form itself says confers no rights on the certificate holder^[1], and an additional-insured endorsement, which is what actually extends your policy to the harbor.^[2] Some harbors, such as Ventura, want the endorsement page attached.^[3]

For harbors in DockDash's vendor requirements data, the certificate holder, additional-insured wording, limits and other requirements are filled in from the harbor's published documents, with the source and the date we checked it. Where a harbor's documents disagree, the letter passes that note to your broker rather than picking one. For any other harbor, type in what the harbor gave you.

The letter is a request, not a contract or a legal document. Your broker decides what your policy can provide. Nothing you type is sent anywhere; "Open in my email app" just starts a draft in your own email program.

Sources

New York State Department of Financial Services. ACORD 25 Certificate of Liability Insurance (sample form) (December 2025). Accessed November 11, 2026 · secondary source
Miller Nash LLP. Why you need more than just a certificate of insurance. Accessed November 11, 2026 · secondary source
Ventura Port District. Commercial Identification Cards. Accessed November 11, 2026