ays to Save
Certificate of Insurance Request
Copyright 2009 Stephen W. Gersh Insurance Agency, Inc. All rights reserved.
*Type of certificate?
*Insured Company Name
*Insured Telephone #
*Certificate Holder Name
Note: Some carriers charge a
fee for Additional Insureds.
Need To Be
*Preferred method for receiving certificate?
Please note that it takes 48 hours for insurance carriers to
assist us with Worker's Compensation certificate requests.