Todays Date: 8/20/2019

Certificate of Insurance Request Form

Your Information
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Fax Number:
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State:
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Zip:
Certificate Holder Information
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State:
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Zip:
Certificate Information
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Choose Property certificate for property loss payees and mortgagees. Select Laibility certificate for the owner of a facility/land you want to use. or participatein. Additional Insured status required by contract or agreement. Auto certificate for leases and auto loans.
Description of Off-Premises event or property/auto/location. Include account and/or lease numbers.
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Please indicate how you plan on forwarding additional information to the Archdiocese regarding this request.
Important Note: If additional insured status is being requested the contract/agreement needs to be either faxed to 410-547-3153 or scanned and e-mailed directly to riskmanagement@archbalt.org by clicking Here
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