"Cobb-Hall is Livingston County's largest independent insurance provider serving clients throughout Michigan."

Request Insurance Certificate

YOU HAVE A RIGHT TO EXPECT TIMELY DELIVERY OF INSURANCE CERTIFICATES

At Cobb Hall Insurance our goal is to issue Certificates of Insurance - including business insurance, personal insurance, workers comp insurance, or other policy - within 24 hours. Please fill in the information below:

Fields marked with * are required

Firm Name:*
Firm Address:*
 
 
 
Certificate Details:
   
Date Requested:*
Requested By:*
Phone Number:*
Fax Number:
Email Address:*
   
Certificate Recipient:
   
Certificate Holder:*
Attention:
Address:*
 
 
Job Name/Number:
   
Coverages and Special Instructions/Requirements
   

Check coverage to be evidenced to Certificate Holder:

General Liability Professional Liability
Auto Liability Worker's Comp Insurance
Excess Liability Other:

Please check any special requirements:

Additional Insured Waiver of Subscription
Primary/Non-Contributory Wording Other:

If you need additional insureds other than the Certificate Holder, provide the complete name(s) here:
   
Additional Instructions:
   
Sending Instructions:* Insured's Copy
  Holder's Copy
   

 

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