As a service to our existing contractor clientele, Business Insurance Associates, Inc. has automated the certificate request process into one simple streamlined form. Complete the information below to submit a request for a certificate of insurance. We will process the majority of all requests within two (2) business hours, and send copies to both the certificate holder and the clientele, unless otherwise specified.

    Contract Clientele (Your Info)
    Your Name
    Business Name
    Fax or Email

    Certificate Holder (Who wants the certificate)
    Business Name
    Street Address
    City, State, Zip
    Fax or Email
      Additional Instructions


      Please indicate if additional insured or waivers of subrogation are required.