781.438.1375
info@lopriore.com
426 Main Street Suite 2
Stoneham, MA 02180
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Certificate of Insurance Request

For an Insurance Certificate, complete and submit the form. Please fax or upload and attach any sample certificate or insurance requirement documents that you have received to ensure the proper handling and processing of your request. Should you have any questions and/or require immediate assistance, please don’t hesitate to call us after your request is completed.

INSURED INFORMATION

CERTIFICATE HOLDER INFORMATION

(Company or individual requesting the certificate from you)

Insurance Certificate Recipient/Handling Instructions. Please let us know where to send the Insurance Certificate; insured, certificate holder or both.

ADDITIONAL COVERAGES AND SPECIAL INSTRUCTIONS

(Check all that apply)

Insurance Certificate FAQ’s

What is an insurance certificate?

A Certificate of Insurance is a standardized form that provides proof of your current in-force insurance coverage at the time of request. The Certificate of insurance includes such information as your business name, policy number, policy effective dates, lines of insurance, and the policy limits of insurance you presently carry.

Is there a charge for an insurance certificate?

No, it is typically provided at no cost on behalf of the policyholder. The only time there would be a charge is when changes to the current insurance policy need to be made to satisfy certificate holder request.

Who needs an insurance certificate?

An insurance certificate is generally requested by landlords, mortgagees, banks, general contractors and customers looking for proof of insurance coverage for the business.

How long is an insurance certificate good for?

The certificate is good for the term of the policy unless the policy is cancelled prior to the expiration date listed on the certificate.

What happens if my policy is cancelled during the policy period?

If your policy is cancelled during the policy period all issued certificate holders will be notified that the insurance policy was cancelled.

Download a sample insurance certificate