Certificate of Insurance Request

You have the option of requesting Certificates of Insurance on the following electronic form. It is important to include as much information as possible. We will review your request, contact you if further information is required, and then send the certificate of insurance to the appropriate party(s).









    Address of Holder
























    FaxEmail


    Required Coverages




    AutoEquipmentUmbrellaWorkers' CompensationGeneral LiabilityBuilders Risk




    YesNo


    YesNo




    YesNo


    YesNo


    YesNo


    Comments or Other Instructions




    Attach File







    HOURS

    Monday-Friday: 9:00am – 5:00pm
    Weekends & Evenings: By Appointment

    Our agency is licensed in the state of Ohio.


    Indepedent Insurance Agent
    The Romig Agency 124th Anniversary