Certificates – Commercial Insurance Important Certificate Request InformationWe 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*Get my approval firstProceed with requestIf 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? 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. Address of Certificate Holder / Additional Insured* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code 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 NotesThank 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.
