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REQUEST FOR PROOF OF INSURED OR ADDITIONAL INSURED
You can also call us to get a quote by phone or to have any of your questions answered
888-900-9989
Day(s) Hours
Monday - Thursday 7:00 a.m. - 6:00 p.m.
Friday 7:00 a.m. - 5:00 p.m.
  • Please make sure to indicate whether you need in a Proof of Insurance or an Additional Insured Certificate
  • Adding an entity as an Additional Insured on your policy means that they are now named insured on your policy
  • Proof of Insurance is provided free of charge. Additional Insured endorsements are often free of charge as well, but the cost will vary with type and insurance company
  • Additional Insureds are subject to approval by your insurance carrier. Approved Additional Insureds will receive an endorsement modifying your policy

 

Insurance Holder Information
Name:  Policy#:
Phone:  Email:
Please indicate your requirements below by checking the appropriate box
Proof Of Insurance $0
Additional Insured (AI) Often $0, however the cost will vary with AI type and insurance company
Please note any specific AI requirements:

ADDITIONAL INSURED MUST BE PAID UP FRONT PRIOR TO ISSUANCE (IF APPLICABLE)
(You can find payment-by-fax forms on our web site under the Forms/Documents tab
or click here)

Please complete the following describing the Additional Insured or Proof of Insurance Holder
To:
Address:
City, State, Zip:
Attention:
Phone:
Fax:
Please complete the following for Additional Insured requests
(not required for Proof of Insurance)
Start Date:    (NOTE: If over 30 days past, you will need a no loss letter)
Job Location: One location Various locations
Street Address:
City, State, Zip:
List all counties:
Job Description:
Is this a residential project? Yes No
What is the expected duration of the job (in days)?    Expected total cost?  
What is the number of field employees on the job site for the AI (include the owner)?
Principal use of property:
(Residence, Nail Salon, Law Office, Restaurant, etc)		  
Work Subcontracted Out:
Additional Insured’s relationship to the policyholder: (please check one below)
      General Contracting  Owner  Landlord  Public Entity/Permits
      Prop. Management  Retail Supplier  Lender  Warranty/Referral Firm
      Engineer  Architect  Other:
 Does the AI maintain primary insurance to cover the exposure risk?  Yes  No
Check any of the items below that the job involves:
      Tract Homes  Condos  Townhouses  Apartments  Loft Conversions
      Work is for National Retailer
 Other:
What is the job type?
     New Construction Remodel Service/Repair Apartments
Do you have a written contract with the AI? Yes No

 

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