Online Contractor Certificate Requests: Quick & Convenient Date MM slash DD slash YYYY please format as: mm/dd/yyyyPlease select Auto Workers Comp General Liability Umbrella Other Please indicate the contract requirements of written contracts.Additional Insureds by Line of Business Auto General Liability Umbrella Other Additional InsuredsWaiver of Subrogation Auto General Liability Umbrella Other By (Requested)*From (Business Name)*Email* Phone*Certificate Holder InformationNameAddressEmail (or fax) Email preferred Return to:Please enter email, fax number or mailing address of recipientPlease send me a copy of the Certificate: No Yes Certificate will be mailed, faxed or emailed per your request.NOTE: Certificates for Workers Compensation policies written through the MA Workers Compensation Risk Plan must be issued directly by the insurance company wiriting the policy. RogersGray will order the certificate which will be issed by the carrier within two (2) business days. A copy will be kept on file for the insured unless instructed otherwise. Certificate will be available within 24 hours.
