InfiniTeam Insurance | Request Certificate

REMINDER: To expedite your request and to eliminate potential underwriting declinations, please forward a copy of the insurance requirements found in your contract. With the ever-changing legal environment and insurance carrier regulations, lack of information can and will delay our normal service and quick turn-around time.

There may be an additional cost for additional insured endorsement requests, per project aggregates and/or waiver of subrogation requests.

Customer Name:*
Contact:*
Customer Email:
Customer Phone:
Customer Fax:

Certificate Holder:*
Street Address:*
City:*
State:*
Zip:*

Job Reference:
Certificate Holder Email:
Certificate Holder Phone:
Certificate Holder Fax:

Please fill out the section below for

additional insured(s) or waiver of subrogation.

Cancellation Notice:

10 days
30 days

Additional Insured(s)?

Primary &
non-contributory wording?

Yes
No

Waiver of subrogation required?

Yes

Per project Aggregate?

Yes
No

For any Additional Insured and/or Waiver of Subrogation request, the following items are required:

Name of Job:
Project # (if any):
Does this project involve tract homes or multi family dwellings:	Yes No
Description of job:
Total cost of job:
Total payroll for job:
Completion Date:

Will you be sending additional contracts via fax or email?	Yes No