Contractors Insurance Specialists 866.941.3631

Certificate of Insurance
Disclaimer: Insurance transactions are NOT effective without acknowledgement from a Contractors Insurance Specialists representative.

Click here for a printable version to mail or fax us (Otherwise, proceed below to submit an online form to our e-mail).

Items marked with * important to fill out but not required. Please fill in as much of the online form as you can.

*Contact Name:

*Email:

*Please Issue Certificate To:

Attention:

*Company Name:

*Address

*City

*State

*Zip Code:

*Phone:

Fax:

*Job Name/Number:

*Description & Location:

Special Requirements:
(charges may apply)

	Additional Insured Endorsement
	Waiver of Subrogation
	Primary Wording
	Cross out "endeavor to" and "but failure to mail..." in cancellation section of ACORD form
	Certificate only

*Sending Instructions:

	FAX directly to certificate holder FAX #:

	FAX Certificate to us

If you're not a bot, slide to the right to reach at least 90.