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COVID-19: Follow public health measures during the stay-at-home order

Forms and applications

Certificate of Insurance Forms

Individuals and organizations who supply goods and services to the City or who use City facilities must provide proof of insurance.

The certificate you need depends on what type of contract, purchase order, permit, licence or other form of agreement you have with the City. These forms must be completed by your insurance broker or insurer. The forms below are the only certificates accepted by the City.

Please make sure your certificate shows which City department or contact it should be directed to. If you have any questions please ask your City contact or email risk.management@mississauga.ca or call 905-615-3200 ext. 3922.

Documents

  • PDF
    Standard Liability
    Nov 20, 2020
    Complete this form as proof of liability insurance. This can be used for agreements, permits, leases, or licenses for activities, programs or special events.
  • PDF
    Facility Rentals
    Feb 6, 2020
    Complete this form as evidence of insurance for special events and City facility rentals.
  • PDF
    Construction Liability
    Nov 20, 2020
    Complete this form as proof of liability for infrastructure design, construction or road maintenance work within the City. For example, large renovations, new builds, sidewalk or road repair contracts, parks, subdivisions.
  • PDF
    Property
    Nov 20, 2020
    Complete this form as proof of property and machinery insurance, or any construction related insurance. For example, large renovations, new builds, sidewalk or road repair contracts, parks or subdivisions.
  • PDF
    Professional and Cyber Liability
    Nov 20, 2020
    Complete this form if you are a consultant or other professional undertaking work for the City. This work could include geotechnical, engineering, design or architectural work, or other specialized consultations.
  • PDF
    Homeowners/Residential Liability
    Nov 20, 2020
    Residential homeowner must use this form as proof of insurance to the City as part of an encroachment agreement or similar contract.