Certificate Request

CERTIFICATE OF INSURANCE REQUEST

From time to time, you may be in a situation that requires proof of insurance. And usually, you need to provide proof quickly. At Cleveland Insurance, we believe that you have a right to expect timely delivery of Certificates of Insurance.

Certificate Holder Information

By completing this online form, you agree to having read the following disclaimer:

This information is not an offer to sell insurance. Insurance coverage cannot be bound or changed via submission of this online form/application, e-mail, voice mail, or facsimile. No binder, insurance policy, change, addition, and/or deletion to insurance coverage goes into effect until confirmed directly with a licensed agent. Note, any proposal of insurance we may present to you will be based upon the values developed and exposures to loss disclosed to us on this online form/application and/or in communications with us. All coverages are subject to the terms, conditions, and exclusions of the actual policy issued. Not all policies or coverages are available in every state. You also agree to release us from any liability if this information is accidentally viewed by unauthorized persons. We will only use this information for insurance quoting purposes and not to distribute to other parties.