Commercial Certificate of Insurance Step 1 of 3 33% Business Name*Business Contact Name* First Last Phone*Can this Phone Receive Text Messages?*Please SelectYesNoEmail* Text and Email Consent* We will text and email you a reference number for this changeEmail Consent* We will Email you a reference number for this change. Name of Additional Insured*Please enter the name of the additional insuredAdditional Insured Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code For your Certificate Do you Need a Clause added?*Please SelectYesNoSometimes when contracts are sign we need to add wording to your certificate so they will accept it. Did the Additional Insured give an Example?*Please SelectYesNoAdditional Insured Clause*Please type word for word of what they are requesting. This is very important and if approved change your insurance policy. Upload Additional Insured Documentation*Max. file size: 39 MB.
