Vendor Input COI Certificate of Insurance

Vendor Input COI Certificate of Insurance

Enter Insurance Details

Name of Vendor

(ie. ABC Construction, Inc.)

Department*

Select

Town's Contract Manager*

Select or enter value

Vendor Contact Name*

Vendor Contact Email*

Vendor Contact Telephone Number*

Insurance Agent Name*

Insurance Agent Email*

General Liability Expires*

General Liability Amount*

Auto Expires

Auto Amount

Umbrella Policy Expires

Umbrella Amount

Worker's Comp Expires

Worker's Comp Amount

Professional Liability Expires

Professional Liability Amount

Environmental Liability Expires

Environmental Liability Amount

Excess Liability Expires

Excess Liability Amount

Upload Insurance Certificate*

Label file - [expiring year & month] [COI] [Company name]

YYYY-MM-COI-Company name EG: 2024-08-COI-ABC COMPANY

Drag and drop files here or

Send me a copy of my responses

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