Commercial Certificate of Insurance Request Form

Share

  • Requestor Information

  • What is the requestor's first name?
  • What is the requestor's last name?
  • What is today's date?
    MM slash DD slash YYYY
  • What date do you need the certificate of insurance by?
    MM slash DD slash YYYY
  • What is the requestor's phone number?
  • What is the requestor's email address?
  • Please enter any special instructions in the box below.
  • Please upload applicable files here.
    Drop files here or
    Max. file size: 128 MB.

    • Certificate Holder's Information

    • Please enter the certificate holder's name. (Ie. Lender, lessor)
    • Please enter the certificate holder's loan number, if applicable.
    • What is the certificate holder's address?
    • Is there any special language that needs to be included on the certificate?

    • Delivery Method

    • What is the certificate holder's email address?
    • Please enter the certificate holder's fax number.
    • Please enter the address of the Unit Owner or Job Location.
    Agent Save & Continue

    Danielle Rice

    In the spring of 2022, Danielle joined Avery as a Senior Commercial Risk Specialist. In her role, Danielle will work with Avery clients to develop comprehensive insurance programs and recommend risk management solutions, security policies, business continuity plans, and recovery measures. Prior to joining Avery Insurance, Danielle’s professional experience includes nearly twenty years as a senior account manager in the insurance industry. Her passion for cultivating strong client relationships coupled with a desire to help clients make informed decisions led her to Avery. Danielle has earned her Accredited Customer Service Representative (ACSR) designation and she is a Commercial Lines Coverage Specialist (CLCS) providing expert knowledge in commercial lines of coverage: general liability, commercial property, workers compensation, and business auto, as well as insurance principles.

    Back to Profile Share