Ross & Associates Insurance Services, Inc.
9201 SE 91st Avenue, Suite 220 - Portland, OR 97086
503-698-3833 contactus@ross-ins.com
 
Certificate Request

Please complete all questions to assure proper and timely issuance of your Certificate of Insurance.

 

Please send a copy of any contract and/or supporting documentation under separate email to contactus@ross-ins.com.

FOR WRAP/OCIP PROJECTS WE NEED A COPY OF THE CONTRACT



*Insured:
*Requested by:
*Phone#:
*Email:
*Certificate Holder:
*Address:
*City, State Zip
Fax#:
Email:
Additional Remarks: