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CERTIFICATES OF INSURANCE

Please complete the following form, and a Certificate of Insurance will be issued on your behalf evidencing current coverage in accordance with the information you provide. It is important to note that the coverages, terms and conditions you currently have in place may not necessarily comply with the contractual insurance requirements. If you have any questions or require additional assistance, please contact our office (877) 474-2821.

 

Certificate of Insurance Requested By:
Contact Name:
Insured Name:
Telephone:
Email Address:

Please Issue Certificate of Insurance To:
Certificate Holder Name:
Attention:
Address:
City:
State:
Zip:
Project Reference:
Required Coverage(s) / Additional Insured(s) / Other Special Requirements:

IMPORTANT NOTE: Additional Insureds cannot be added to Professional Liability or Workers Compensation policies. Additional Insureds cannot be added to a General Liability policy unless required by a written work contract or agreement and are subject to acceptability and approval by the Insurer.

Special requirements such as “material change/notification of limit reduction/absolute notice of cancellation or non-renewal” are not available. Additional restrictions may apply.

Sending Instructions:
Mail:
  Original to holder – copy to insured
  Original & copy to insured only
Fax:
  Holder        Fax#: 
  Insured      Fax#: 
  Other          Fax#: 
Email:
  Holder        Email Address: 
  Insured      Email Address: 
  Other          Email Address: 

Please Allow 48 Hours Turnaround Time
D i f f e r e n t   b y   D e s i g n ™
Hilb, Rogal & Hobbs
Architects & Engineers
Phone: 877.474.2821
Fax: 877.474.2822
aeinfo@hrh.com

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