Certificate of Insurance Request - Commercial Insurance Customers Only

Fill out the form below to request a certificate of insurance from Wagner Insurance.

Client Information

* Policy Number
* First Name:
Middle Initial:
* Last Name:
* Name of Company:
* Email:
* Address:
* City:
State: WA
* ZIP:
* Phone:

Certificate Holder Information

* Full Business Name:
* Address:
* City:
* State:
* ZIP:
Does this certificate holder require Additional Insured Status?
Does this certificate holder require Primary Status?
Does this certificate holder require Non-Contributory Status?
Does this certificate holder require a Waiver of Subrogation?
How would you like the certificate sent?
Who should the certificate be addressed to?

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Disclaimer: Wagner Insurance will make every possible effort to issue your certificate of insurance request within one business day of the request but due to certain Insurance Company regulations we cannot guarantee this timeline.

Additional Insured Status, Primary Status, Non-Contributory Status, and Waiver of Subrogation may not be available to all client's due to the coverage's provided in the client's insurance policy.

Additional Insured Status, Primary Status, Non-Contributory Status, and Waiver of Subrogation requests may generate substantial premium charges to the client's policy. By submitting this request you are acknowledging that premium charges may be associated with this request and that you will be invoiced by Wagner Insurance for these charges. Submitting this request also acknowledges an agreement to pay these charges as invoiced. Failure to pay these charges within the invoiced timeline will result in non-payment cancellation of your insurance policy.