Request a Certificate of Insurance

Please fill in the following information to submit your request for a certificate of insurance. Our turnaround time for online requests is generally 24-48 hours.

Please check with your Account Manager on additional premiums that can be associated with Additional Insured and Waiver of Subrogation Endorsements.

Certificate of Insurance

Date:*
Your Company Information
Named Insured Information
Contact Name:*
First Last
Contact Number:*
Contact Business Name:*
Contact Business Address:*
Contact Email:*
Contact Fax Number:
Today’s Certificate, do you want us to send it directly to the Certificate Holder noted below?
Any RUSH Request - ALERT us by e-mailing us @ certs@preferins.com with the subject line: RUSH COI Request or by calling 703-667-5940
- Yes
- No
CERTIFICATE HOLDER INFORMATION
Individual, Company or Organization to whom we will provide proof of coverage.
Is this a Revision to an Existing Certificate?*
- Yes
- No
Provide certificate holder name or attach previous certificate below:
Attach previous certificate
Business Name:
Attention (Full Name):
First Last
Certificate Holder Mailing Address:
Certificate Holder Email Address:
AT RENEWAL - All Certificates will be sent to the Insured and the Certificate Holder, therefore please provide us with an email Address and/or Fax Number
Additional Certificate Holder email addresses (as needed)
To provide additional email addresses, click on the "+", and a new line will be added.
Certificate Holder Fax Number:
Project Information
Project Information*
You must provide type of work being performed.
Project Address*
You must include the State.
Additional Insured
As part of your business dealings, you may be asked to provide coverage for a customer by adding the customer to your policy as an Additional Insured. This extends your coverage to the third party requestor. An example of this would be a Municipal Entity or General Contractor. If this information is provided, your policy will need to be endorsed to add this entity to your policy as an Additional Insured. Please be advised that there may be additional premium required for this change.
Additional Insured Name
Additional Insured Address
Must provide a mailing address for each additional insured.
Additional Comments / Instructions:
Attach additional requirements
CAPTCHA
Comments
This field is for validation purposes and should be left unchanged.

Disclaimer

Communications to this insurance agency by electronic mail or voice mail CANNOT be considered as binding or otherwise effective for ANY insurance protection/policy coverage. Our office will contact you via e-mail to confirm any information sent and please look for the policy change endorsement to follow. If you do not receive this endorsement from the insurance carrier, contact your agent immediately. Thank you.

Request Your Risk Review

Get the Right Coverage For the Best Value.

Request a Certificate of Insurance

Certificate of Insurance

Your Company Information

Today’s Certificate, do you want us to send it directly to the Certificate Holder noted below?

CERTIFICATE HOLDER INFORMATION

Project Information

Additional Insured

Request Your Risk Review

Risk Review Request