Request a Certificate Your Information Complete the form below and we will review your request. If we have everything we need, we'll email the certificate directly to you within one business day. StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Certificate Holder Information (The organization requesting the certificate from you) StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming SPECIAL REQUESTS Special RequestsShow Certificate Holder as Additional Insured.Additional Information/Special Wording. Event Information Start Date End Date Important Information IMPORTANT INFORMATION ABOUT A CERTIFICATE OF INSURANCE What is a certificate of insurance? A certificate of insurance is a document that lists the coverages and limits in your insurance policy. When someone asks you for a certificate of insurance, they're interested in confirming your insurance coverage and limits. How do I get one? We provide our customers with certificates of insurance for their policies. All you need to do is send in a request or give us a call. How do I name someone as an additional insured? You may have been asked to name the individual or business as an "additional insured” on your policy. Brotherhood Mutual allows you to designate an additional insured for most general liability coverages on a certificate of insurance without making changes to your policy. Each insurance provider may handle this differently. Does the certificate of insurance change the terms of my policy? It does not. A certificate of insurance can never be used to change the terms of your policy. Coverage for additional insureds is strictly subject to the terms of your policy. If you are asked to provide a certificate with additional coverage or limits, or if you are asked to provide “loss payee” or “mortgage payee” status, please give us a call so we can talk with you about what changes may need to be made to your policy. I acknowledge that I have read and understand the Important Information about a Certificate of Insurance.
