Certificate Request

The Getchell Companies issue their clients a document known as a ‘Certificate of Insurance’ that displays the coverage of the insurance policies that the business carries.

Certificates of Insurance are commonly required by a business’ clients to make sure that their subcontractors, tenants, and other interests have appropriate insurance coverage.

If you are one of our current clients and need a certificate of insurance, please complete the form and submit it to our office. This is instantly delivered to your account manager and we will issue the certificate to you within one business day. If you need it sooner, please make a note to us in the special instructions section.

Name of Insured*

Requested by*

E-Mail Address

Fax* (123) 456-7890

Certificate Holder*

Attention*

Address*

City*

State

Zip*

Special Instructions

Coverage Requested: (please check all that apply, at least one is required)

 General Liability Automobile Liability Garage Liability Excess/Umbrella Liability Workers Comp & Employers Liability Other

Description of operations/Special provisions