Construction & Contractor Insurance - Certificates of Insurance

111 Natoma St.
Folsom, CA 95630
ph: 800-864-5774
fax: 888-663-9259
alt: 916-752-7042
info@devconins.com

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Certificates of Insurance

Please complete the form below in order to obtain a Proof of Insurance or an Additional Insured Certificate. If you prefer to fax your request, please complete the attached form by Clicking Here and fax back to (888) 663-9259.

*Insured Name:

*Contact Phone:

*Email:

*Type of Request:

Proof of Insurance (No Endorsement) Additional Insured Endorsement

Proof of insurance is free. Additional Insureds (A.I.) are often included in the premium, however costs can vary based on type.

*Name of Entity Requesting to be Additional Insured:

*Certificate Holder Address:

Please enter Company Name, Address, Attn:, Phone, & Fax

Certificate Holder Email:

*Type of Project:

Residential Project Commercial Project Industrial Project

*Type of Work:

Ground up Construction Remodel and/or Addition Service or Repair

*Relationship to the Policyholder:

General Contractor Project Owner/Homeowner Referral Service/Warranty (i.e. Home Depot) Property Manager Public Entity/Permits Architect/Engineer Other

*Project Location:

One Location Various Locations

Estimated Contract Cost:

Specific Location (if any):

Special Wording:

Waiver of Subrogation (General Liability) Primary Wording (General Liability) Waiver of Subrogation (Workers' Compensation) CG 2010 11/85 (Commercial Work Only)

If there are more specific instructions or attachments, please detail below or e-mail to Certs@DevConIns.com or fax to (888) 663-9259.

Special Instructions:

Date & Time Certificate Needed:

Submit Your Request:

Any questions please feel free to call @ (800) 864-5774 or just click the button at the top of the page to be connected.

111 Natoma St.
Folsom, CA 95630
ph: 800-864-5774
fax: 888-663-9259
alt: 916-752-7042
info@devconins.com