COI (Certificate of Insurance) Form Your Name (or name of Insured as it appears on policy): * Your Phone: * Your Email: * Name of Additional Insured: * Person or Organization Name Address of Additional Insured: * Street #, Street, City, State, Zip Date of Event: * Date COI is Needed: For non-urgent requests, leave blank. You can expect a COI within 1-3 business days. Any specific language requested by the additional insured?