Gordon Insurance is here to assist our customers. In order to expedite your request, please fill out as much as you can in the below form. You are not required to fill out everything. If you have any questions, give us a call! 

This form is to facilitate a quicker response time to get your Certificate out to your Clients. Should your Clients give you any special instructions or samples, please let us know the EXACT WORDING.

Feel free to email us the sheets at [email protected] or put the info in the Special Instructions Section.

Certificate of Insurance

Insured Information

Certificate Holder

Company or individual requesting the certificate from you
Address of Certificate Holder
Address of Certificate Holder
Are there any additional coverages or special instructions required?

Additional Coverages and Special Instructions

Check all that apply, if any
Is certificate holder to be named Additional Insured?
Is Primary and Non-Contributory wording required?
Is Waiver of Subrogation required?
Is certificate holder a Loss Payee or Landlord?

Maximum file size: 104.86MB

Please let us know where to send the Insurance Certificate. Click all that apply
How to send the certificate? Click all that apply