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