Additional Insurance Requested

Insured Information

Your Company Name *

Policy Number *

Your Name *

Your Email *

Which type of certificate you are needing? *

Proof of Insurance
Certificate Holder / Additional Insured
Additional Insured Certificate
Renew Existing Certificate(s)

Certificate Holder Information

Certificate Holder *

Address *

Would you like us to send the certificate directly to the certificate holder? *

Yes
No

Email *

Additional Insured Information

You are requesting an Additional Insured Certificate. It is your responsibility to review your policy and your work contract to make sure that the Holder of the Certificate actually qualifies as an Additional Insured under the terms of your policy. Hunter Insurance will not review your work contract and will not provide insurance advice to your Certificate Holder. You are strongly advised to consult an attorney to make sure the terms of your policy meet the needs of you and your Certificate Holder in light of your work and your contract.

Which type of policies apply to the Additional Insured? *

General Liability
Auto
Excess/Umbrella

Does your insurance need to be primary and non-contributory? *

Yes
No
Not Sure

Does the Certificate Holder require a Waiver of Subrogation? *

Yes
No
Not Sure

For which type of policies does the waiver apply? *

Worker Compensation
General Liability
Auto

Does the Certificate Holder need a Completed Operations Endorsement? *

Yes
No
Not Sure

Is this project residential or commercial?

Residential
Commercial

(copy) *

Are there multiple jobsites for this additional insured? *

Yes
No

Please Provide Cities or Counties of Jobsites *

Project Address *

What are your expected gross receipts for this project? *

Project Summary *

Do any other companies/individuals also need to be additionally insured on this certificate? *

Yes
No

Other Individuals or Companies *

Is there a written contract between your company and the Additional Insured? *

Yes
No

Is this project covered under a WRAP or OCIP policy? *

Yes
No

Do you know which certificate(s) need to be renewed? *

Yes
No

We will email you a certificate holder list to review.

Would you like to include any additional wording on the certificate or upload an example certificate? *

Yes
No

Click or drag a file to this area to upload.

NOTE: Please make sure your file names do not include special characters (such as / : * ? " < > | &). Please only use letters, numbers, and dashes in the file name. Failing to do so may delay your request. Thank you.

Other Requirements Below

Insured Information

Certificate Holder Information

Additional Insured Information

Contractor Insurance

Business Insurance

Personal Insurance