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Contact
Name |
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Name of Business |
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Street
Address |
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City |
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State |
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ZIP |
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Email |
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Certificate Holder |
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Phone |
-
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Fax |
-
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Best
time to call |
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Additional
Information |
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Brief
description
of work to be preformed plus location and
cost of job |
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VERY
IMPORTANT |
Does this Certificate Holder need to be Named
on your policy as an ADDITIONAL INSURED?
Remember that by adding an Additional Insured,
you are agreeing to share your insurance limits
with this person or company should you both
be sued. The company has a right to charge
an additional premium for adding an additional
insured. |
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Please
check one |
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YES,
please add this certificate holder as an Additional Insured
for General Liability Insurance |
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|
NO,
do not add this certificate holder as an Additional Insured. |
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Certificates
will be issued on the day
they are received or the next business day.
If special attention or information is needed
on the Certificate please note accordingly.
If questions arise from our agency make
certain to leave your contact number where
you can be reached—especially if the
Certificate is of an urgent nature.
Thank you for your assistance. |
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