REQUEST A CERTIFICATE | REPORT A CLAIM
 



Alamosa Office
Map to location
719.589.3611

Colorado Springs Office
Map to location
719.528.1884
Request Certificate

Contact Name: *  
Contact Phone Number *  
Contact Email Address: *  
   
Insureds Name:
Certificate Holder Name:
Address:
City:
State:
Zip:
   
General Description
Coverages General Liability
Worker's Compensation
Umbrella
Automobile Liability
Automobile Physical Damage
Property / Contents
Equipment
Other
The certificate holder needs to be named as: Additional Insured
Loss Payee
Mortgagee
Primary
Non-Contributory
Waiver of Subrogation
Other
Handling Instructions: Mail Certificate
Fax Certificate:
       Attention:
       Fax Number:
Email Certificate to:
(email address)
   

Please note: This is an alternative method for communicating with us. We will contact you as soon as possible after receiving your request.
Copyright © 2008 CIA-Leavitt Insurance Agency - Legal Information