Certificate of Insurance

Certificates of Insurance issuance service is available for Porter & Yee Associates, Inc. clients. Clients can either request a certificate of insurance by mail, fax, email or by completing and submitting this page. To maintain confidentiality, we do not accept certificate of insurance requests by anyone other than our clients.
 

This Certificate is for:*

(CTRL + click to select multiple selections)

If you have specific certificate of insurance needs or if you
need other insurance coverages indicated, please contact
our office at (212) 732-4575
Company Information
Name:*
Company's Name:*
Company's Address:
 
Phone Number:
Fax Number:
Email Address:*
   
 
Certificate Holder
Name of Holder:*
 
Address:*
City:*
State:*
Zip Code:*
Attention:
 
Additional Insured Request Information
Additional Insured
 
Name:

Address:

Additional Insured Type:
How would you like
to receive the certificate?*
Would you like to receive the original certificate in mail?
Yes No
   
"I UNDERSTAND THE FOLLOWING:
  • Certificates cannot be issued with incomplete name and address.
  • Certificates can be issued only for current coverage placed through Porter & Yee.
  • Certificates can only be issued on ACORD forms.
  • Amend Additional Insureds:
    Additional Insureds can only be included if your policy includes the coverage. Please contact our office if you have any special requirements
I have read and agree with the above