Certificate of Insurance Request

Certificate of Insurance Request

Propak Certificates of Insurance (COI) for customers or vendors should be requested using this form. Requests to add a company as a certificate holder only will be automatically sent to Stephens (Propak's insurance broker) and emailed or faxed as indicated on the request. Certificates that require additional insured status, endorsements to our policies, or special language in the description will be routed to the Risk Management Department for approval. You will be contacted if additional information is needed.
Your Name:*

First NameLast Name
Your Email address:*
example@example.com
Location or Division:*
Please provide the following information on the person and company requesting the certificate.
What is the company's relationship with Propak?*
Entity name as it should appear on the COI:*
Address as it should appear on the COI:*

Street Address

Street Address Line 2

CityState

Zip Code
Contact with requesting company:

First NameLast Name
The certificate will be emailed to you if an email or fax is not provided for the requesting company.
Email the COI should be sent to:
example@example.com
Fax No. the COI should be sent to:

Area CodePhone Number
Please send the certificate:

Directly to the company requesting it and copy me.Directly to me and I will forward to the company representative.
Types of Certificates:

Enhanced COI (Preferred): An enhanced COI for Propak includes Auto Liability, General Liability, Workers' Compensation, and Employer's Liability with $1m limits along with Motor Truck Cargo at $100,000 limits.

Standard COI: A standard COI for Propak includes Auto Liability, General Liability, Workers' Compensation, and Employer's Liability with $1m limits along with Motor Truck Cargo at $250,000 limits. This certificate also includes umbrella and excess policies of $10m for general liability and employer's liability and $14m for auto liability.
What type of certificate is being requested?*

Enhanced COI with the company listed as certificate holder only [Cargo limit $100,000 and primary coverage only]Standard COI with the company listed as certificate holder only [Cargo limit $250,000 with primary and umbrella coverage]Enhanced COI with the company listed as additional insured or with other special languageStandard COI with the company listed as additional insured or with other special languageI'm not sure or need help. (A member of the Risk Management Department will contact you)
When additional insured status, endorsements to our policies, copies of insurance policies, or special language is required, additional information is needed by the Risk Management Department. Certificates indicating additional insured status will state "if required by written contract" on the COI. In order to request this certificate, a copy of the written contract signed by or email confirmation of intent to sign by a Vice President must be provided. Contact your manager and obtain the necessary approvals prior to requesting the COI.
For Additional Insured status only - Upload the agreement or email it with approval to agreements@propak.com.

Browse Files

Cancelof
Which fits best?

This is a new relationship. A COI has not been issued in the past.A COI has been issued in the past and only an updated form is needed.
Certificate requests typically take 2-4 hours to process. Indicate below if the request is urgent and we will make every effort to expedite our response.
Is this an urgent request?

Yes, I need the COI as soon as possibleNo, but I need the COI within 2-4 hoursOther
Any comments or additional information we should know about this request?
Should be Empty:

Certificate of Insurance Request

Please provide the following information on the person and company requesting the certificate.