Certificate of Insurance Request Form

Commercial insurance clients of Horst Insurance may use the form below to request that a Certificate of
Insurance (COI) be issued on their behalf. Please complete all the fields of information so that we may
provide the most accurate COI possible. We strongly encourage you to also include a copy of the COI
request that you received from the certificate holder. There is an option at the bottom of the request
form below for you to attach a scan of that request. COIs are generally processed within 24 hours
during normal business days.

Your Information

Certificate Recipient/Holder Information

Certificate Information

AutoGeneral LiabilityBuilders RiskEquipmentProfessional LiabilityUmbrellaWorkers' Comp

Unless you specify differently, Auto, General Liability and Workers’ Comp will be the only policies indicated on Certificate (when applicable).