Insurance Exception Approval Form
Use an explicit exception process when a vendor cannot meet a requirement. A documented business decision should identify the remaining exposure rather than relabel deficient evidence as compliant.
Download the original TXT template
How to use it
- Describe the exact contract requirement and the submitted evidence.
- Have the authorized risk or contract owner evaluate alternatives and any owner consent needed.
- Set an expiration and revisit the decision at renewal, scope change or project extension.
Customize the template
Your entries stay in this browser tab. Leave a field blank to keep its placeholder in the download.
INSURANCE EXCEPTION REQUEST Vendor / project: [Vendor and project] Requirement: [Contract requirement] Evidence submitted: [Actual evidence] Gap and reason: [Difference and vendor explanation] Work dates / exposure: [Scope and period] Proposed controls or alternatives: [Controls] Owner / upstream consent needed: [Consent requirement] Decision: [Approve with conditions, decline or request more evidence] Conditions: [Conditions] Authorized approver / role: [Name and role] Approval date / reference: [Date and reference] Exception expires: [Date] Review trigger: [Renewal, scope change or other trigger] Follow-up owner: [Name] Attach the supporting correspondence and retain the original unmodified insurance evidence.
Example in practice
A one-day delivery vendor cannot provide the requested umbrella limit. The authorized reviewer records the decision for that delivery only, rather than waiving the limit for all future work.
This form does not amend the vendor contract or insurer policy. Obtain any approvals or amendments required by the actual agreement.