Certificate of Insurance Request Template (Simple)

Ask a vendor, contractor or tenant to provide a certificate of insurance with the limits and additional-insured wording you require.

Use this free template Free account, so you can save and send it. Log in

Simple Full Plain-English Summary

Simple: a 1–2 page short form with just the core terms.

This template is not legal advice; consult a licensed attorney in your state. Insurance is regulated state by state: some states restrict assignments of benefits and direction-to-pay forms, require specific claim or cancellation notices, or require a licensed agent or adjuster. Your insurer may also require its own form.
E-Sign Auto is not a law firm and does not provide legal advice.

Find an attorney to review this → Business/Corporate & Contracts attorneys who offer a free consultation. Not an endorsement.

1. Parties2. Details 1/23. Details 2/2

Parties

Signing order: Requesting Party → Vendor / Contractor (acknowledgment). Each signer is invited after the previous one signs.

1. Requesting PartyFull name *Email (to send the signing link)

2. Vendor / Contractor (acknowledgment)Full name *Email (to send the signing link)

Signature, date and name fields are added for every signer automatically.

Details 1/2

Effective date *Your company *Vendor or contractor company *Project, lease or contract *Required coverages and minimum limits (GL, auto, workers comp, umbrella)Names to show as additional insured

Details 2/2

Certificate holder name and addressCertificate due by *Send the certificate to (email) *

Use this free template (sign up)

Signature, initials (every page) and date fields are placed for each party. You can review and adjust them before sending.

Live preview

What the sections mean (plain English)

RENEWALS AND CHANGES: How changes to the work, price or schedule must be agreed in writing.

How to use this Certificate of Insurance Request template

Answer the guided questions. Your name and company fill in automatically from your profile.
Pick the governing state and complete the [STATE-SPECIFIC] blanks. Switch optional clauses on or off.
Check the live preview, then create the document. Signature, initial and date fields are placed for each party.
Review the fields and send. Each party signs in order, and everyone gets the signed PDF.

Frequently asked questions

Is this Certificate of Insurance Request template free?

Yes. You can fill it in, download it and send it for electronic signature with a free E-Sign Auto account.

Is an electronically signed Certificate of Insurance Request legally binding?

In the U.S., the federal ESIGN Act and state UETA laws generally give e-signatures the same effect as handwritten ones. Check your state's rules.

Does this template work in my state?

It is a generic, state-neutral starting point. Pick your governing state and complete every blank marked [STATE-SPECIFIC]. This template is not legal advice; consult a licensed attorney in your state.

Who signs, and in what order?

Requesting Party, then Vendor / Contractor (acknowledgment). Each signer gets a secure link in that order, with signature, initial and date fields already placed.