17 Pond Street
PO Box 546
Sharon, MA  02067

 

Phone:
Fax:
Email:

781-784-3920
781-784-8543
info@shuffaininsurance.com

 
Certificate of Insurance Request
This page is intended for contractors only.  If you are looking for assistance with any other business or personal insurance needs, please contact us.  To request a commercial Certificate of Insurance, please fill out the following form:
Policy Number   (if you know it)
Date
Insured's Name
Email Address
Name of Certificate Holder
Street Address
City, State & ZIP Code
Job Name/Property Name
Location Address

Special Requirements

 Yes  No

Certificate Holder
"Named Additional Insured"

 

Additional Requirements

Special Forms to Attach
Additional Comments