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    Request a Certificate
    of Insurance

    Your Name:
    E-mail Address:
    Telephone Number:
    Policy Number/
    Named Insured
    (From Policy Declarations):
    Certificate Information:

    Name of Additional Insured/Certificate Holder:

    Address

    City                                                          State        Zip


    Project Name/Description:


    Special language requirements or instructions regarding this certificate:


    Is a License or Permit Bond Required?
    No    Yes  Limit:
    How should this certificate be handled?

    Please mail the certificate to me.
    Please mail to the certificate holder at the address indicated above.
    I will pick up the certificate at your office.
    Please fax the certificate to:
           Fax Number:                 Attn:
             
    Please mail to the person/persons indicated below.
           Name:
           
           Address:
           
    Please call me for instructions.
             
    Contact Us
    Harris Insurance Inc.
    335 Frankfort Road
    Shelbyville, KY 40065

    Telephone:
    (502) 633-2212

    Fax:
    (502) 633-2217

    E-mail Us

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