Building Use Form Instructions

  • The following items must be completed on the certificate of liability insurance:

    • Today's date in the upper right hand corner.
    • Producer - name, address, telephone, fax, and contact person of the insurance agency issuing the certificate.
    • Insured - name and address of the building permit applicant.
    • Company A - name of insurance company.
    • The following columns must be completed: type of insurance, policy number, policy effective date (MM/DD/YY), policy expiration date (MM/DD/YY) and limits.

    Monmouth Beach Board of Education, is named as an additional insured for the use of property address to be entered per the application. Insurance coverage is primary and non-contributory and waiver of subrogation applies. 10 day notice of cancellation of insurance will be given to the certificate holder Monmouth Beach Board of Education

    General Liabiilty Coverage Not Less than $1M including Umbrella in the amount of $1M. Sports related events must include accident coverage as well.

    Any third parties using their vehicles and have employees working on premises, please provide Automobile and Worker's compensation insurance certificate as well. Automobile coverage $1M Combined Single Limit and Worker's compensation is statutory limits.

    • The Description of Operations/Locations/Vehicles/Special Items must be completed. Monmouth Beach Board of Education should be listed here as an additional insured in respect to the applicant's operations. The date, name and address of the facility being used should also be listed here.
    • Certificate Holder: The Monmouth Beach Board of Education, 7 Hastings Place, Monmouth Beach, NJ 07750. should be listed here.
    • Cancellation: number of days must be typed in.
    • Authorized Representative: signature required.

Sample of Certificate of Liability Insurance

Building Use Form