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AUTO LEAD SHEET
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COI & EOI Form
(609) 587-1717
COI & EOI Form
Clients Name
Who do you want to list on this certificate?
Another business or individual?
Yes
No
Nobody, this is only for informational purposes.
Is there a written contract, agreement or permit with the certificate holder?
Yes
No
Select any specific wording the certificate holder requires:
Additional Insured - This means a 3rd party covered by the liability or commercial auto policy
Waiver of Subrogation - Waives the right to allow The Hardford to see additional reimbursement after a claim is paid.
Notice of Cancellation - Sends advanced , written notice to the certificate holder or 3rd party of the policy is canceled.
Primary and Non-Contributory - This determines the order in which multiple policies are applied to the same loss.
ATIMA (as Their Interests May Appear) A phrase added to the policy that protects 3rd parties from loss. It’s often requested by financial institutions.
Job Description/ Contract Number - Optional field used to reference a job description or contract number.
Custom Wording - Don’t select custom wording unless the certificate holder asks for special language.
I don’t require any wording.
Who is the certificate holder?
A landlord or property manager
A vendor
A lessor - owns equipment this business rents
A franchisor - a person or business that sells or grants its business model to a franchise
A government entity
Other
Please enter the certificate holder details (This is the name of the third party requesting the certificate, not your name).
Name
Name Continued (optional)
Address:
City:
State:
Zip:
Submit
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