AI Requests Additional Insured Certificate or Certificate Requests Please compete the form below to request either an “Additional Insured” Certificate request or just a Certificate. Certificate Request Please check all boxes for which either an "Additional Insured" certificate is required or just a Certificate is requiredIt is upon you to know weather you need an Additional Insured Certificate or just a Certificate. We strongly urge you to use "best practices" when requesting any certificate. For assistance call (209) 223-1870File upload for indemnity requirements .pdf file format preferred Drop files here or Select files Accepted file types: pdf, jpg, Max. file size: 128 MB, Max. files: 2. You may upload your "indemnity" portion of your certificate requirement here. Please allow up to 48 hours for review. If this is an emergency please call us at 209 223-1870. You may also fax the indemnity agreement to (209) 223-3227.What "type" of insurance certificate are you requesting? Designated Insured Endorsement / Certificate Included. This is a NICO specific Certificate and endorsement and NOT an Additional Insured Certificate Additional Insured Certificate (may include a cost. Check with your Broker/Agent) Certificate only (Not a cost item. This is NOT an Additional Insured Certificate nor does it include any endorsemnt. I have not a clue please help me USE THIS FORM "ONE" PER REQUESTIf you need multiple please complete it multiple times. check all that apply Commercial Auto / Transportation General Liability Loggers Broad Form Liability Product Liability Workers Compensation Pollution Liability Farm General Liability Lessors Risk Name of Person making this request* Email* Enter Email Confirm Email Business Name* Our Insured's name first and last First Last Details if a construction job. Start date, type of work performed and project costCertificate holder informationName of Certificate holder or Additional Insured* Email of Entity requesting the Certificate Address* Street Address City State / Province / Region ZIP / Postal Code Project name in a few words summarize the projectWould you like to attach any documents? Yes No File Drop files here or Select files Max. file size: 10 MB, Max. files: 5. NameThis field is for validation purposes and should be left unchanged.