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Certificate of Insurance

A certificate of insurance is a warranty from our office to a third party that the coverage’s summarized in the form are in force. This is the standard method for people that you do business with to verify your insurance coverage.

You can Request a COI by completing this quick form, or by clicking the link at the bottom of the page:

Your Name

Your Email

Your Phone Number

Your Business Name (required)

Coverage Required to Show on Certificate:

Other comments or information regarding coverage? i.e. specific limits, carrier details, dates of coverage (this year and last year's certs?), etc. Be specific, please.

Any Endorsements Required?

Other comments or information regarding endorsements? i.e. specific form numbers, specific form edition dates, specific working in description of operations box, etc (see "included attachment" function below to include a sample certificate).

Legal Entity Name Requesting Certificate:

Their Address:

City
ST
ZIP

Certificate Holder Contact Name:

Cert Holder's Phone Number

Cert Holder Fax # To Send COI To:

Cert Holder Email to Send COI To:


Upload a Copy of the Insurance Requirements from your Contract (Or a Sample Certificate) or any other supporting documentation for this request.

Do you have any special handling instructions for our team?

A few quick footnotes:

1. Certificate Holders generally only want to see proof of your coverage. There is not a charge from your insurance company for our office to issue a “Certificate Holder” copy of a certificate of insurance.

2. Additional Insured status (Briefly) By adding an entity to your policy as an additional insured you are protecting that entity against your company’s negligence. By having another entity add your business as an additional insured that company is protecting you against their negligence. There is typically a cost for this endorsement and it depends on the contract language being required of you by your third party.

3. Waiver of Subrogation: Subrogation is how the insurance world works. Your insurance steps into action when something happens and the carrier defends you, pays a claim or settles with the third party who brought the claim against you. Then your insurance company will subrogate (go looking for another party to make the carrier whole). If you waive your carriers rights of subrogation that is a restrictive endorsement and is generally bad. However, it is often a cost of doing business in many cases with larger entities.

download and fax this Certificate Request form.

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