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Certificate of Insurance 
Certificate of Insurance
Insured Information
  Insured Name:  
 
 Policy Number:  
  
 
 Insured Phone Number:  
  
Certificate Information
 
 Name of Company or Certificate Holder:  
  
 
 Job Reference Number:  
  
     
  Certificate Holder Street Address:  
  City:     State:    Zip:  
 
 Certificate Holder Email Address:  
 
 
Certificate Holder Fax:  
   (include area code)
Requesters Information
 
Your Name:  
  
 
Contact Email Address:  
  
 
Handling Method:  
 
   (if other, please describe in comments area below)
Required Coverages  
 
Please provide copy of  
insurance requirements of contract:  
  Auto
  Umbrella
  General Liability 
  Equipment
  Workers' Compensation
  Builders Risk
 
General Liability Description:
     
 
Need Endorsements for Waiver of Subrogation:
Yes   No
 
Need Endorsements for Primary Wording:
Yes   No
 
Additional Insured:
Yes   No
 
Loss Payee:
Yes   No
 
Mortgagee:
Yes   No
Comments or Other Instructions:
 

By submitting this form you understand that no coverage is bound until you receive written notice. Changes to policies via this website are not effective or binding until you, or any party involved, receive official notification from your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.
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Exceptional savings for "average" people.

“We have been working with Winooski Insurance for over 10 years. Joe keeps us abreast of any and all new regulations that might have an impact on our industry or business. Because of this we have enjoyed nice dividend checks from our workers comp carrier. Contact Joe or one of his staff for any of your insurance needs.”

Mike Gervais
Prime Renovation Group, Dream Maker Bath & Kitchen of Vermont

“I use Winooski Insurance personally and also refer them to my clients. Their rates are very competitive and their staff is friendly and effi cient.”

Mark Chaffee
Mortgage Financial, Inc.


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