Certificate of Insurance Request

Commercial insurance clients of The Richards Group may use the form below to request that a Certificate of Insurance (COI) be issued on their behalf. Please complete all the fields of information so that we may provide the most accurate COI possible. If there are specific requirements or instructions from the holder, please be sure to enter that information below or if you have a PDF, please send as an attachment to info@therichardsgrp.com. If this request is coming directly from the Certificate Holder, the COI will be issued as soon as permission is granted from our Insured. 

Your Information
Date *
Date
Your Contact Phone Number *
Your Contact Phone Number
Certificate Receipt/Holder Information
Certificate Information
Do you have a contract with the Holder? *
What coverages do you need included? *
Please enter any special instructions you feel appropriate for this certificate.

*Please be advised that coverage may not be bound nor amended by this email message. Please be assured that the information you submit will be treated as confidential. certificate will be issued within 24 hours after being confirmed by our insured.