COI Additional Insured Form
Add your company as additional insured to our certificate of Insurance. There is a $349 charge to be added as additional insured. Please allow up to 14 business days for proccessing this request.
Requester Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
What is your job title at your company?
*
Enter Company Information Needed For COI Below
Company Name
*
Company Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Payment Method
*
Credit Card
Signature
*
Date Signed
-
Month
-
Day
Year
Date
*
Categories:
All
All
Insurance Options
prev
next
( X )
Insurance Options
COI Additional Insured
One-Time Payment to be added as additional insured.
$349.00
$
349.00
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Submit
Submit
Should be Empty: