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Is this a new building to be added or an existing building already insured?
If there is not a value for a required field, please input "0."
A Certificate of Insurance (COI) is used to notify a third party (not the member) that coverage is in place for specified circumstances. Must note the name of the Certificate Holder (the third party) requesting the COI, if they have an interest in the property (Loss Payee), and what are the circumstances requiring the COI.
If this location is on the National Historic Registry, please indicate this in the space above.
For more information, contact Underwriting at (919) 719-1170 or email firstname.lastname@example.org.
The County/Entity will receive an endorsement as confirmation of all changes.
This field is not part of the form submission.
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