ACEC Business Insurance Trust

Meet The Trust      Business Insurance      Small Business Insurance Center      Professional Liability Insurance      Member Resources
  Member Resources  
  Request a Certificate of Insurance  
  Location Change/Addition Form  
  Vehicle Change/Addition Form  
  Important Questions  
  Loss Control Library  
  Business Insurance Claims Information  
  Professional Liability Claims Information  
  Business Insurance Billing & Audit Information  
  Professional Liability Billing Information  
  Contact Us  
 
Request for Certificate of Insurance Print PDF

Need to report a new or additional office location? If you are a current policy holder, use our simple form below. Completion of this form does not bind or alter your coverage. A representative from Marsh USA, Inc. will contact you.

Firm Name:
State:
Request Type :

New Location

Delete Location; #

Date Effective :
 mm dd yyyy
Location Address:
Location County:
City: State: ZIP:

Building Specifications

Are you the tenant or owner of the building?

Tenant Owner
Year Built:
If the building is over 30 years old, please provide year of updates:

Wiring: Roof: Plumbing: HVAC:

Construction Type:
Office Building?
Yes No
Number of floors:
Sprinklers:
 %
Do you occupy the entire building? Yes No
How many square feet do you occupy?

Coverages (please provide replacement cost limits)
Building:
 $
Contents:
 $
(Excluding computer hardware, media, data, phones, faxes and copiers)
Engineering Equipment:
 $
(Equipment taken more than 1000ft. off insured premises that is owned, leased, borrowed or rented)
Computers & Media:
 $
(Including data, phones, faxes and copiers)
Other buildings or storage locations ? Yes No
Landlord/Mortgagee on property? Yes No
If you answered yes, please fill in his/her contact information below
Name:
Address:
City: State: ZIP:

Special Instructions and Requirements
Requested By:
Date Requested:

Home Contact Marsh USA, Inc. Site Map About ACEC Webmaster

This is a communication from Marsh USA Inc., the Program Administrator.
The ACEC Business Insurance Trust, together with Marsh USA, Inc., makes available both Business Insurance and Professional Liability Insurance.