← Back to Forms Request for Certificate of Insurance Certificates will be processed within 24 hours of the time they are received by our office. Step 1 of 5 - Requestor 0% Requested ByName(Required) First Last Email(Required) Delivery Standard RUSH RUSH Certificates are defined as certificates that are required for a move happening that same day. Rush Certificates will be processed within a 3 hour window from the time they are received by our office. Rush certificates should be an exception rather than a rule. Aegis is ready to accommodate in emergency situations and provide rush certificates; however, we need your assistance in keeping these to a minimum. Moving Company Name & AddressName(Required) Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Certificate Holder Name & AddressBuilding, Property Manager, Owner, etc. who is requesting certificate. Please provide complete name & address or there will be a delay in processing.Name(Required) Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Regarding: (Tenant name, Apt #, Move date, Property location) Endorsement Requirements (check appropriate boxes)General Liability Additional Insured Waiver of Subrogation Primary Auto Additional Insured Waiver of Subrogation Primary Workers Compensation Waiver of Subrogation Additional Insureds(Required) Add RemoveThose entities associated with this move who require their names be listed on certificate.Additional DocumentationPlease provide copy of building requirements, or other relevant documentation, if available. Drop files here or Select files Max. file size: 100 MB. Return Certificate ToSignature(Required)Email(Required) Add RemoveProvide email addresses for all who should receive a copy of the certificate.
