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 Accepted file types: pdf, jpg. 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? Additional Insured Certificate Certificate only (no additional insured need be added) 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 General Liability Product Liability Workers Compensation Commercial Auto Pollution Liability Loggers Broad Form 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 Please select the type of Certificate needed* Certificate only - no AI Additional Insured Certificate Not sure Certificate holder informationName of Certificate holder or Additional Insured*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 EmailThis field is for validation purposes and should be left unchanged. Share this:TwitterFacebookLike this:Like Loading...
