Certificates – Commercial Insurance

Important Certificate Request Information
We know Certificates are a very important part of your business and we understand they are needed timely. **Send your request at least 48 business hours prior to your deadline/job starting. **Fill out the form COMPLETELY **Be aware your policy must be in good standing, and not pending cancellation. **We are unable to alter, amend or add coverage or verbiage on the Certificate of Insurance.
Type of Request
- Certificate Only: just needing proof that you have current insurance.
- Certificate with Additional Insured: You are providing a certificate naming someone as Additional Insured on your policy( i.e. management company, person you're doing a job for, etc). *This request may incur additional costs*
Additional Cost Notification*
If there is an additional cost to add an Additional Insured, or an endorsement, do you want to give approval first or proceed with the request?
Your Name / Your Company Name*
First Last
Business Name*
What is the name of the business this request pertains to. N/A if not applicable.
Your Email Address*

Which email address would you like this Certificate of Insurance to be sent to?
Alternative Email Address
If you'd like the Certificate of Insurance to be copied to a Certificate Holder or Additional Interest, please include their email here.
Which Line of Business?*
- General Liability
- Business Auto
- Umbrella
- Workers Comp
Please let us know which line of business you are needing a Certificate of Insurance for.
Name of Certificate Holder / Additional Insured*
Name of the company/person requesting a Certificate of Insurance from you. *If you don't need a Certificate Holder, please add your business name here.
Address of Certificate Holder / Additional Insured*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

This is the address for the Certificate Holder or Additional Insured. *If you don't need a Certificate Holder, please add your business name here.
Do you have a Written Agreement in place with the Certificate Holder (listed above) that requires they are added as an Additional Insured?
- Yes
- No
This is just for your information: Not all written agreements you may have with your contractors require a Certificate Holder be added as an Additional Insured. Without that request in writing, it may impact how a claim is handled.
Are there any additional endorsements required by the Certificate Holder?
Please list any additional endorsements or requirements by the Certificate Holder. These might include: Waiver of Subrogation endorsement, Primary and Non-Contributary endorsement, etc.
Comments/Additional Notes
Thank you for using our online form! If you have any additional notes, questions or comments, please note them here. *NOTE: You will receive a confirmation or follow up with additional questions within 24-48 business hours.

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Certificates – Commercial Insurance

Important Certificate Request Information

Request Your Proposal Here