Client Service

Request a Certificate of Insurance.

Provide the certificate holder, delivery and job details our licensed service staff need to process the request.

Use this form for a Certificate of Insurance. Requests involving additional insured status, waivers, policy changes or insurer approval may take longer than a standard certificate.

Your name (required)Insured business name (required)Your email (required)Your phone (required)Policy number, if knownCertificate needed byCertificate holder’s legal name (required)Certificate holder street address (required)City (required)State (required)ZIP/postal code (required)Delivery email (required)Attention/contact nameJob or project nameJob location

Coverages to show

Additional insured requested?Waiver of subrogation requested?Primary and noncontributory requested?Completed operations requested?Special wording or instructions

I am authorized to request this certificate for the insured business. I authorize Liberty Union Insurance Group to deliver the certificate to the certificate holder or delivery contact listed above. I understand this request does not bind, add or change coverage. Certificate and endorsement requests remain subject to the policy and insurer approval.

Do not include Social Security numbers, driver’s license numbers, payment information or medical records. A certificate is evidence of insurance and does not amend the policy. Formspree processes this submission; see our Privacy Policy.

Liberty Union Insurance Group, Inc. is the independent agency behind LibertyUnionIns.com and this content. Visit us at 1347 19th St., Plano, TX 75074 or call 972-423-2300.