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Certificate of Insurance

REQUEST LIABILITY INSURANCE


YOU MUST SPEAK WITH YOUR MANAGEMENT COMPANY BEFORE COMPLETING THIS FORM

Certificate processing fee - $75.


When you are speaking with your management company please request these items:

Who should be listed as the "Certificate Holder"?
What address should be listed for the "Certificate Holder"?
Who should be listed as "Additionally Insured"?
Does the building need to see proof of Workers Compensation?

Ww hold the following policies:
$1,000,000 Commercial General Liability
$2,000,000 General Aggregate
$5,000,000 Excess/Umbrella Liability
$300,000 Commercial Automobile Liability

Full Name:
Contact Phone:
Email Address:
Move Date:
Address of Residence Requiring Insurance:
(Please Include Apartment/Unit #)
Name of Tenant at this Address:
Certificate Holder:
Address of Certificate Holder:
(please include City, State, ZIP)
Phone Number of Management Co.:
Fax Number where Certificate should be sent:
Contact Name at Management Co.:
Who Should Be Listed as "Additionally Insured"?
(please note that tenant, address and date of move
will automatically be added to the certificate)
Does your building require
proof of Workers Compensation?
YES
Additional Comments:
  
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