Kohlnhofer Insurance AgencyRequest Certificate of Insurance952-469-4968moc.refohnlhok@ofniCertificate of Insurance Request Form1Company Information2Personal Information3Entity Request Information4Policy Selection5Additional DetailsCompany Name*Company Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Name* First Name Last Name Email* PhoneRequesting Company Name*Requesting Company Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Requesting Company Attn (Optional)Requesting Company Phone (Optional)Requesting Company Fax (Optional)Requesting Company Email (Optional) Select the insurance policies that must appear on the certificate. Please note: Additional insured endorsements may be subject to an additional premium.General Liability Include General Liability?Do you also want to include: Include Additional Insured? Waiver of Subrogation?Commercial Auto Include Commercial Auto?Do you also want to include: Include Additional Insured? Waiver of Subrogation?General Liability Include Commercial Umbrella?Do you also want to include: Include Additional Insured? Waiver of Subrogation?Workers Compensation Include Workers Compensation?Do you also want to include: Waiver of Subrogation?Special wording required on the certificate? (Optional)Additional Remarks (Optional)CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
