Workers’ Compensation Certificate of Insurance


Waiver of Subrogation Certificate Notices :

  • Fees vary based on carrier. Please contact your CSR for cost prior to submitting the request
  • All Waiver of Subrogation certificates are subject to carrier approval and can take up to 3 business days to process.
  • Note: “Additional Insured” only applies to general liability insurance certificates, not workers’ compensation certificates.

Submitted By*:

Client Company Information:

Insured Company Name*:
Your Phone Number*:

Distribution (A copy should be emailed in PDF to):


A copy should be faxed to:


Certificate Holder Name*:

Special Instructions (Processing time may vary for certificates requiring special instructions):