Online Request
This Certificate of Insurance Request Form is for existing clients of our agency who hold Commercial policies. Please provide as much information possible to receive an accurate certificate. This information will be kept strictly confidential and will be used for these purposes only.
* Indicates Required Field.
Insured Information
| * Insured Making Request: | |
| Address: | |
| City: | |
| State: | |
| Zip: | |
| * Phone: | |
| Fax: | |
| * Email Address: | |
A confirmation e-mail will be sent to you once the certificate has been processed. |
|
Recipient Information
Please issue Certificate of Insurance to the following:
| * Name: | |
| * Address: | |
| * City: | |
| State: | |
| Zip: | |
| * Job Reference: | |
| How would you like the certificate to be sent to the recipient?: | |
| Fax Email | |
| Fax #: | |
| Email: | |
| * Attention: | |
Certificate Information
| * Policies to Reference: | |||||||
|
|||||||
* Unless specified, all current policies on file with Frenkel will be indicated on the certificate. |
|||||||
| Additional Insured: | May incur additional premium charge. General Liability Auto |
||||||
| Waiver of Subrogation: | May incur an additional premium charge. General Liability Workers' Comp. |
||||||
Special Instructions
NEW* All certificates will be emailed to the Certificate holder unless otherwise instructed.
*Please advise of the insurance requirement if special items are needed.
Please click on the "Submit Request" button to send your Certificate request. One of our representatives will respond to your submission as soon as possible.