CERTIFICATE REQUEST PROCEDURE:

1. Download the following Certificate Request Form (requires Adobe Acrobat): or complete the online request form below:
Certificate Request Form
Additional Insured Request Form

2. Fill out completely and fax to 1-800-251-1284.

No policy can be changed, endorsed or amended without a formal request in writing and it must be confirmed in writing by the carrier.

Certificate Holder is the name of entity requesting proof of insurance. Please complete the form online form below to submit your request online.

Business Name of ProWorks Client * Required
Contact Name of ProWorks Client * Required
Certificate Holder
Address Street and Number * Required
City * Required
State * Required
Country
Zip Code
Phone * Required
Email Address * Required
Which policies do you need a certificate for ?
General Liab Automobile
Work Comp Other
Additional Insured:
Does the certificate holder
need to be named as Additional Insured?
Notes:
IMPORTANT ! PLEASE READ !
• To expedite certificates or endorsements, please attach any paperwork or requirements provided by the contractor.
• Certificates of insurance will be faxed and mailed to you, your certificate holder, and whomever else you list in the notes, within 48-hours or less.
• Certificates with Additional Insured must be done by the Insurance Company and may add additional time.
• No policy can be changed, endorsed or amended without a formal request in writing and it must be confirmed in writing by the carrier.
 




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