Certificate of Insurance
Disclaimer: Insurance transactions are NOT effective without acknowledgement from a Harris & Associates representative.

Click here for a printable version to mail or fax us (Otherwise, proceed below to submit an online form to our e-mail).

Items marked with * important to fill out but not required. Please fill in as much of the online form as you can.

*Your Company Name:
*Contact Name:
*Email:
*Phone:
*Certificate Holder Name and Address:
*Job Name/Number:
*Description & Location:
Special Requirements:   (charges may apply)	Certificate Only Additional Insured Endorsement
*Sending Instructions:	Email/Fax directly to certificate holder   Email/Fax Certificate to us