A Certificate of Insurance is used to provide proof of insurance coverage to a certificate holder.
Your Business Name (required)
Coverage type required by certificate holder (check all that apply)
General LiabilityCommercial AutoPropertyWorker’s Compensation & Employer’s LiabilityExcess Liab.
Certificate Holder Name (required)
Street Address (required)
Job Description / Location
Does certificate holder need to be named as:
Loss Payee? YesNo
Additional Insured? YesNo
By adding an additional insured, you are agreeing to share your insurance limits with this person or company should a claim occur. Your insurance company has the right to charge an additional premium for adding an additional insured.
Special Fax Instructions
Special Email Instructions