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Please provide us some information about the certificate request, so we can process this as soon as possible.
Contact Information:
Your Name
*
Your Company Information
*
Contact Phone
*
E-mail
*
ALINK Customer Information:
Name of business/insured
*
Certificate Holder Information:
Name
*
Mailing Address
*
Address Line 2
City
*
State
*
ZIP Code
Fax
Email
*
Preferred Delivery Method
*
Fax to Holder
Email to Holder
Postal Mail to Holder
Line of Business Requested
*
General Liability
Commercial Auto
Umbrella/Excess Liability
Workers Comp
Property
Equipment
Other
Special Requirements and Endorsements
(Additional Premium may apply)
General Liability
*
Evidence of Insurance Only
Additional Insured
Additional Insured ( Completed Ops)
Waiver of Subrogation
Primary Language
No Special Requirements
Commercial Auto
*
Evidence of Insurance Only
Additional Insured
Waiver of Subrogation
Loss Payee
No Special Requirements
Property/Equipment
*
Evidence of Insurance Only
Loss Payee
Mortgage
No Special Requiements
Workers' Compensation
*
Evidence of Insurance Only
Waiver of Subrogation
No Special Requiements
Cancellation Notice Requirement
(Additional Premium may apply)
Notice of Cancellation to Holder
Project Information
Required for Additional Insured and Waiver of Subrogation
Do you have a written contract in place for the project with the certificate holder listed above?
*
Yes
No
Notes:
Submit
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