Certificate of Insurance Request

You have the option of requesting Certificates of Insurance on the following electronic form. It is important to include as much information as possible. We will review your request, contact you if further information is required, and then send the certificate of insurance to the appropriate party(s).

Please note that any incoming e-mail requests to Witkin Scott Associates, Inc to bind, effect, or amend coverage, terms or conditions of any policy or submit a claim shall not be treated as having been received until formal acknowledgement has been sent to the originator of the e-mail. An automated response advising of the absence of the addressee member of our staff does not constitute a formal response.

  • General Information

  • Required Coverages

  • Drop files here or
    Please attach written request(s) and/or contracts received, if any.
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