Certificate Request

CERTIFICATE CENTRAL

Created for top tier customers of Machor Sage & Kava Insurance
We hope you like this new feature for certificates. Our intent is to make the process accessible to you and those requesting certificates 24/7, ensure complete and accurate information, and provide you with a copy of your request. Although we are always available by phone, we know that your time is valuable and we constantly work to make like easier and more profitable.

Please provide the information below. We will review your request and contact you if we need further information. We will then send the certificate to the appropriate party(s). To ensure accuracy for your certificate, please upload a copy of the contract and the request from the certificate holder.

Remember, please submit your request at least 24 hours before the date and time the certificate is needed.
Do you have a copy of a contract or requirements from the certificate holder to attach?

YesNo
Please attach now

Cancelof
Who is requesting this certificate?

Our CustomerA Certificate Holder
Coverage Required

General LiabilityGeneral Liability/Waiver Of SubrogationBusiness AutoBusiness Auto/Waiver Of SubrogationEmployers LiabilityEmployers Liability/Waiver Of SubrogationOther
OUR CUSTOMER'S INFORMATION

We need this information to issue the certificate.
Company Name*
Contact Person*

First NameLast Name
Their Email Address *
They will receive a copy of this request for their files
Company Phone Number*
Please enter a valid phone number.
CERTIFICATE HOLDER'S INFORMATION

The person or entity requesting proof of insurance
Holder Name*
Holder Address
Please enter Address, City, State, and Zip Code. If the certificate is for information purposes only, please enter INFORMATION PURPOSES ONLY.
Contact Person
If none leave blank
Phone Number
Please enter a valid phone number.
Should a copy of the certificate go directly to the certificate holder?

YesNo
Preferred method

EmailFaxMail
Fax Number
Please enter a valid phone number.
Email Address
It is important that we have an email address to send renewal certificates
Does the holder require to be named as Additional Insured?
Do you need anyone else added as an Additional Insured?

YesNo
Please list all Additional Insureds separated by a comma
It is possible there will be a small additional premium to add Additional Insured's to your policy.
JOB INFORMATION
Job Description, address, etc.
Any Special Wording Or Requirements
This includes anything required by the certificate holder and additional premium may apply
Should be Empty:

CERTIFICATE CENTRAL

OUR CUSTOMER'S INFORMATION

CERTIFICATE HOLDER'S INFORMATION

JOB INFORMATION