Bishop-Lusink Insurance  - Insuring Since 1908
Commerical Certificate Requests
Certificate of Insurance Request
I need this certificate by:
I need a:
Most carriers do charge for additional insured certificates, please contact our office for approximate cost
Insured's Name
Contact Number
Please include the following on my certificate request:
General Liability
Workers Compensation
Commercial Auto
Other: please list in remarks
Certificate Holder Information (need complete name and address)
Please list the relationship/job to the certificate holder
Any special wording requirement? (please list exactly as it appears on your request)
Where would you like your certificate sent:
Mail to insured
Email to insured
Fax to insured
Mail to certificate holder
Email to certificate holder
Fax to certificate holder
Please list the contact information for sending the certificate
Minimum issue time frame for certificates is 1-2 business days depending on the carrier it may take longer.
Additional Instructions or Remarks:
 
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