Request a Certificate of Insurance

Certificate of Insurance Request

A Certificate of Insurance is a document used to provide information on specific insurance coverage. The certificate provides verification of the insurance and usually contains information on types and limits of coverage, insurance company, policy number, named insured (your organization’s name), and the policies’ effective periods. For instance, if you have a mortgage on your property, the bank will request a certificate of insurance and be listed as a mortgagee. If you will be conducting training at a property other than your own, the property owner will request a certificate of insurance and be listed as an additional insured.

Please fill in the form below to the best of your knowledge. We will follow up with any questions. If you have received a written request for a certificate, please forward it to our office by Email, Fax (888) 973-7891, or upload it to our File Exchange Portal.

Name*
First Last
Your Organization Name*
Email*
Phone*
Fax
Certificate Holder Name*
Certificate Holder Address*
Street Address Address Line 2 City State ZIP Code
Please check below if the certificate holder has requested to be listed as any of the following.*
- Mortgagee
- Loss Payee
- Additional Insured
- Lenders Loss payee
- Certificate Holder Only
- Not Specified
Describe the reason for the certificate.*
Delivery Method*
- Fax
- Email