Certificate of Insurance Request Template (US)
Updated on September 25, 2026
This page deliberately does not generate a fake certificate of insurance. Jotform has two high-clone insurance certificate pages, but its own page describes a certificate as a document issued by an insurance company or broker. That is the correct boundary. A business, landlord, general contractor, venue or lender can request proof of coverage; the insurer, producer or authorized issuer supplies the actual certificate.
This US master creates the honest document the user can control: a COI request letter and checklist. It asks for the insured name, producer contact, policy types, limits, certificate holder, additional insured or loss payee wording where appropriate, endorsements, contract reference and delivery deadline. It also explains that a certificate is evidence of coverage, not the policy itself and not a substitute for endorsements.
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Certificate of Insurance Request
- Date:
- Requesting party:
- Insured, vendor or producer:
- Required coverage and contract:
- Project, premises or certificate holder address:
1. Purpose
requests that provide an issuer-prepared certificate of insurance and any required endorsements for at by .
2. Scope and obligations
- will ask its insurer, broker, producer or authorized issuer to provide current proof of coverage matching the requested policy types, limits and certificate holder information.
- will review the returned certificate and request actual endorsements where contract rights depend on policy wording.
- The parties will not alter a certificate or treat this request letter as proof of coverage.
3. Money, timing and records
Required coverage limit or contract value is . This field is a request reference only and does not create, amend or extend insurance coverage.
4. Compliance limits
- This document is a request letter and checklist, not a certificate of insurance.
- Only the policy and endorsements control coverage.
- Certificate-form and wording rules vary by state and by issuer.
5. Notices and evidence
Notices under this document should be sent to unless the parties later agree in writing to another delivery method. Each party should keep signed copies, attachments, receipts, photos, permits, issuer documents, correspondence and other evidence that supports the transaction.
6. Governing law and additional terms
This document is intended to be governed by . Additional terms: . If any required statutory notice, official form, court order, permit, policy endorsement or disclosure applies, that separate requirement controls over a conflicting optional term in this template.
Requesting party
Date signed:
Insured, vendor or producer
Date signed:
Ask for the real issuer document
A certificate of insurance is normally evidence prepared or issued by an insurer or insurance producer. The NCOIL model act defines certificates that way and treats them as evidence of property or casualty coverage, not as the policy, binder or endorsement itself.
That distinction matters. A customer-edited PDF can misrepresent coverage and create fraud or contract-breach risk. This template asks the insured, broker or producer for a current certificate instead of inviting the user to fill one in from scratch.
State exactly what coverage is required
A vague request for proof of insurance produces vague proof. The request should identify general liability, auto, workers compensation, umbrella, professional liability, cyber, property or other coverage as needed. It should also state limits, policy period, project or location, certificate holder and contract reference.
If the contract requires additional insured, waiver of subrogation, primary and noncontributory wording, loss payee status or notice language, ask for the endorsement or policy evidence. A certificate holder box alone may not grant those rights.
Separate certificate holder from additional insured
People often confuse certificate holder status with actual coverage rights. Being named as certificate holder usually means the certificate was issued to that party. Additional insured or loss payee status generally requires policy wording or endorsement.
The request letter therefore asks the issuer to include the required wording only if it is supported by the policy. It does not ask anyone to alter an ACORD, ISO or insurer form beyond what the issuer can properly issue.
Use state insurance-department rules as guardrails
Certificate rules are state-specific. Texas, for example, maintains certificate-form resources through its Department of Insurance. Louisiana notes that standard forms from insurer, ACORD, AAIS or ISO sources are authorized under its current approach. Those examples show why a do-it-yourself certificate is the wrong product.
The right workflow is: review the contract, send a precise request, receive the issuer document, check policy period and limits, and ask for endorsements where the contract requires them.
Keep renewals and expirations visible
A certificate is time-sensitive. Vendors and tenants may have a current certificate at onboarding and then let coverage lapse. The checklist includes policy expiration dates, renewal reminders and the person responsible for updated certificates.
For recurring vendor, lease or project relationships, store the certificate with the contract and calendar renewal review before expiration.
COI request clause guide
- Requesting party and insured
- Names the certificate holder and the person or business whose coverage must be evidenced.
- Producer or issuer contact
- Identifies the agent, broker, producer, insurer or other authorized certificate issuer.
- Coverage requested
- Lists policy types, limits, deductibles, policy period and project-specific requirements.
- Certificate holder
- Gives the exact name and address to appear on the certificate.
- Additional insured or loss payee
- Requests wording only where the policy or endorsement supports it.
- Endorsement request
- Asks for actual endorsements when contract rights depend on them.
- Delivery deadline
- Sets the date and email or portal for delivery before work, occupancy or payment begins.
- Renewal tracking
- Creates a reminder to request updated proof before expiration.
US COI request checklist
Use this checklist to avoid creating or accepting unreliable proof of insurance.
Do not self-issue proof of coverage
NCOIL model language defines a certificate as evidence prepared or issued by an insurer or insurance producer. Use this template to request the real certificate.
NCOIL Certificates of Insurance Model ActCheck state certificate-form rules
State departments may regulate certificate forms, wording or filing. Texas maintains property and casualty certificate-form resources.
Texas Department of Insurance certificate formsUse standard issuer forms where required
Louisiana notes that standard forms promulgated by insurer, ACORD, AAIS or ISO sources are authorized under its current law.
Louisiana Department of Insurance certificate noteAsk for endorsements, not just boxes
Additional insured, waiver, loss payee or primary-and-noncontributory rights may need endorsements. A certificate alone may not change the policy.
Match contract and certificate names
The insured, certificate holder, project, premises and contract reference should match the underlying agreement.
Track expiration and renewal
Store certificates with the contract and calendar renewal requests before policy expiration.
How to request a certificate of insurance
- Read the contract requirement. Identify required policy types, limits, endorsements, certificate holder wording and delivery deadline.
- Name the insured and project. Enter the vendor, tenant, contractor or insured name and the project, premises or contract reference.
- Send the request to the right person. Send it to the insured and, if known, the agent, broker or producer authorized to issue proof.
- Review the returned certificate. Check names, policy period, limits, certificate holder, cancellation wording and requested endorsements.
- Track renewal. Calendar expiration and ask for updated proof before coverage lapses.
Frequently asked questions
Can I create my own certificate of insurance?
No. You can request one, but proof of coverage should come from the insurer, producer, broker or other authorized issuer. Creating your own certificate can misrepresent coverage.
Is a certificate the same as the insurance policy?
No. A certificate is evidence of coverage. The policy and endorsements control the actual coverage, exclusions and rights.
Does being a certificate holder make me an additional insured?
Usually no. Certificate holder status means the certificate was issued to you. Additional insured rights generally require policy wording or an endorsement.
What should I request for a contractor?
Common requests include general liability, workers compensation, auto liability, umbrella coverage, certificate holder wording and any additional insured or waiver endorsements required by contract.
Why include a due date?
Because the certificate should be reviewed before work starts, keys are issued, goods ship or payment is released. A late certificate may reveal a coverage gap after risk has already begun.
What if the certificate has wrong names?
Ask for correction from the issuer. Names should match the contract parties, legal entities, project, premises and certificate holder address.
Can I rely only on the certificate?
For routine vendor screening it may be enough, but if contract rights depend on additional insured, loss payee or waiver language, ask for the actual endorsement or policy evidence.
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Disclaimer
This template and guide are general information only, not legal, tax, employment, insurance, food-safety, child-safety, intellectual-property, landlord-tenant, export-control, privacy, or regulatory advice. No attorney has reviewed your facts. Check current federal, state, local, and industry rules before signing or sending.
