Certificates of Coverage

Conveniently Request a Certificate of Coverage through our website

ICRMA utilizes Certificates of Coverage to evidence our members’ participation in various programs. These certificates of coverage can be used to satisfy the requirements of third parties with whom our members have contracted. When the contract requires that coverage be extended to these third parties, additional covered party status can be granted via endorsement.

ICRMA will attempt to issue a certificate within 48-72 hours after the request has been reviewed and detail verified. ICRMA returns the completed certificates of coverage to the Member, and the Member is responsible for forwarding onto the certificate holder.

Do you need help with contractual risk transfer? ICRMA’s Risk Control Director to provide assistance.

Member Information

First Name *

Last Name *

Member Agency *

Title

Email *

Phone

Issue Certificate To

Organization Name *

Attn

Address *

City *

State *

Zipcode *

Phone

Description *

Coverage Information

Certificate Required

Proof of Coverage Only (No Contract Required)

Additional Covered Party (Contract Required)

If a contract is required, please forward a copy of the agreement/contract/rental application to Bob May.

Contract/Activity Start Date *

Contract/Activity Start Time

Contract/Activity End Date *

Contract/Activity End Time

This is a multi-year contract (and thus should be marked as a recurring request)

Coverage Type

Auto/General Liability Certificate

Workers' Compensation

Waiver of Subrogation

Yes

A waiver of subrogation means your Agency is waiving its right, as well as ICRMA’s, to sue the other party if it causes a workers’ compensation claim.

Property Certificate

Auto Physical Damage Certificate

Since these Programs include commercial insurance programs, the broker must make amendatory endorsements to the policy(ies), i.e. adding a Loss Payee, additions to the property schedule, etc. If your agency does not participate in the ICRMA programs for these coverages, please contact your agency’s broker for evidence of coverage.

Please provide any additional information regarding the coverage type and limits

Supporting Documentation

Upload Files

Feel free to include any additional documentation. If the request is for an additional covered party, please attach the contract.

Send Additional Copy

Full Name

No need to add yourself, as you will recieve an email confirmation. Use the optional fields above for additional recipients of the final certificate.

Services

595 Market St, Suite 2100
San Francisco, CA 94105
ron_green@ajg.com
(415) 536-8432