Certificate Request in Towson, MD | Goldsborough Independent Insurance Services

For certificate of insurance (COI) requests from business and commercial clients.

What category is this for?*
- New Certificate Holder
- Reissue Existing
Certificate Holder Name*
The person or business requesting this certificate
Certificate Holder Address*
Mailing address of the person or business requesting this certificate

Street Address Address Line 2 City State ZIP Code

To what email should we send the certificate?
We automatically send the certificate to our client. If requested, we also send the certificate to the Holder.
List any required language to be shown in the description box
Ex: Additional Insured, Waiver of Subrogation, Primary Non-Contributory, Per Project Limit
Please upload a copy of the certificate request, section of the contract, copy of the lease, or other document describing the certificate requirements
Drop files here or

Max. file size: 2 MB, Max. files: 5.
If the Certificate Holder has provided you with a Sample Certificate with their requirements, upload it here
Drop files here or

Max. file size: 2 MB, Max. files: 5.
List any special requests or instructions here
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