Skip to main content
#
Correira Insurance Agency, Inc.
 Certificate of Insurance 

Certificate of Insurance

Insured Information
Insured Name:
Policy Number:
Insured Phone Number:
Certificate Information
Name of Company or Certificate Holder:
Job Reference Number:
Certificate Holder Street Address:
City:
State: Zip:
Certificate Holder Email Address:
Certificate Holder Fax:
(include area code)
Requesters Information
Your Name:
Contact Email Address:
Handling Method:
(if other, please describe in comments area below)
Required Coverages
Please provide copy of insurance
requirements of contract:
Auto
Umbrella
General Liability
Equipment
Workers' Compensation
Builders Risk
General Liability Description:
Need Endorsements for Waiver of Subrogation:
Yes No
Need Endorsements for Primary Wording:
Yes No
Additional Insured:
Yes No
Loss Payee:
Yes No
Mortgagee:
Yes No
Comments or Other Instructions

By submitting this form you understand that no coverage is bound until you receive written notice. Changes to policies via this website are not effective or binding until you, or any party involved, receive official notification from your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

123 Broadway Taunton, MA 02780

Phone: 508-822-2999

HOURS:

Mon.- Fri. 8 to 5

Sat. 9 - 12

Remember to make a copy of your auto  registration. If you loose the original you will save $25 for a copy at the registry.

Manage My Policy 

© The Correira Insurance Agency, Inc., 2016 Powered By: Insurance Web Designs   webmail login