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Certificate of Insurance
Request a Certificate of Insurance (COI) if you have an existing commercial insurance coverage through the Cassidy Insurance Agency.
Please provide information regarding you and your company (our customer).
Company Name*
Contact Name*
Email Address*
Phone Number*
If applicable, please provide information regarding the project you need this COI for.
Project Name
Project Number
Please provide information for the Holder of this Certificate of Insurance (this is usually the party that requested this COI of you).
Name of Certificate Holder (this is not you)*
Address*
City*
State*
Zip Code*
Email Address*
Phone Number*
Has your certificate holder asked you to include any of the following enhancements?
Additional Insured?
Select one...
Yes
No
Waiver of Subrigation?
Select one...
Yes
No
Primary & Non Primary Contributary?
Select one...
Yes
No
Loss Payee?
Select one...
Yes
No
Additonal Notes as Needed
Please upload any relevant files with your request
(e.g. Sample COI, Contract, Specifications, etc.
)
Upload File
Max file size 10MB.
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Thank you! Your submission has been received!
If you need to request another Certificate of Insurance,
please click here
.
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We offer personalized service to help you get the best coverage for yourself, your family or business.
