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NPS Form 10-550(Rev. 11/2016) OMB Control No. 1024-0268 <br /> National Park <br /> Service <br /> Expiration Date: 11/15/2019 <br /> We require the insurance broker to note this rating in the Certificate. If the rating does not appear on the certificate, <br /> the insurance broker must provide it in another document. <br /> Proof of Insurance Submission <br /> Applicants must submit proof of insurance with the CUA Application.The proof of insurance must: <br /> • Be written in English with monetary amounts reflected in USD <br /> • Reflect that insurance coverage is effective at time of CUA Application submission <br /> • Name as insured the business or person that is providing the service <br /> • Name the United States as additionally insured <br /> • Reflect a General Commercial Liability Policy with the minimum coverage amount required in the CUA Application <br /> • Reflect required additional insurances (commercial vehicle,vessel, aircraft, etc.)with the minimum coverage amount <br /> required in the CUA Application <br /> • Include insurance provider rating or provide in separate document <br /> Page 13 of 21 <br />