SAMPLE COI DOWNLOAD & INSTRUCTIONS

SAMPLE COI DOWNLOAD & INSTRUCTIONS

IMPORTANT!

  • For General Liability & Auto COI: The “ADDL INSR” column MUST be checked with an “X” or “Y” and the “SUBR WVD” column MUST be checked with an “X” or “Y”
  • For Workers Comp COI:  the “SUBR WVD” column MUST be checked with an “X” or “Y”


Nationwide Security Service, Inc.
 should be Listed as Additionally Insured on the Descriptions of Operations Box  and the Certificate Holder box at the bottom.

It is also recommended that your insurance agent supplies the corresponding endorsements or references to their policy numbers identifying the coverages requested as they apply and with respect to the Waiver Of Subrogation in force on the GL, Auto, and WC policies.

CERTIFICATE HOLDER BOX:

Nationwide Security Service, Inc.

   208 Broadway

   Malden, MA 02148

Company Owner's Name
Max. file size: 100 MB.
Please be sure your document has the proper endorsements.
Is this form being filled out by an insurance broker?(Required)
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