Note: The commissioner retains the right to increase the face amounts set forth above as needed in order to prevent waste and to protect public health, safety, and welfare or the environment.
Commercial Facility Certificate of Liability Insurance
I hereby certify that the wording of this instrument is identical to the wording specified in LAC 43:XIX.511.E as such regulation was constituted on the date this certificate was issued, as indicated below, and that the insurer is licensed to transact the business of insurance, or eligible to provide insurance as an excess of surplus lines insurer, in one or more states, and is authorized to conduct insurance business in the state of Louisiana.
[Signature of authorized representative of Insurer]
[Type name]
[Title], Authorized Representative of [Name of Insurer]
[Address of Representative]
Date of Issuance:_________________________.
La. Admin. Code tit. 43, § XIX-511