Certificate of Insurance

Your Name

Your Phone Number

Your Email Address

Your Company

Transportation Customer request (GL - $1M per occurrence/$2M aggregate, AL -$1M, Cargo - $100K, WC - Statutory, EL - $1M)

Vehicle/Trailer rental (GL - $1M per occurrence/$2M aggregate, AL - $1M, Auto Physical Damage, Additional Insured, Loss Payee, Rental Clause)

Misc. equipment rental (GL - $1M per occurrence/$2M aggregate, Property, Additional Insured, Loss Payee, Rental Clause)

Customer Building Owner, Property Manager, or Landlord request (GL - $1M per occurrence/$2M aggregate, AL -$1M, Statutory WC, $1M EL)

Other - specify

Name

Address

City

ZIP/Postal Code

Fax Number (If certificate is to be faxed)

Email Address (If certificate is to be emailed)

Separate multiple addresses by commas

Auto Liability

Limit

Additional Insured

Name(s) of Additional Insured

General Liability

Limit (per occurrence)

Limit (aggregate)

Additional Insured

Name(s) of Additional Insured

Workers' Compensation / Employer's Liability

Limit for Employer's Liability

Waiver of Subrogation

Cargo Liability

Limit

Describe any other types and limits of coverage required

Include specific contract/lease language required if standard certificate is not adequate

2464 maximum characters

One-time Deliveries (XPO Last Mile & XPO Courier)

Shipment/Order Number

Recipient

Comments

2464 maximum characters

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