Certificate of Insurance Request This form is for Unit Owners only. If you are business client with us, please continue to email your request to [email protected] for fastest turnaround. Our new certificates platform does not accept fax numbers. Please provide an email address so that renewal certificates can be sent automatically in the future (replacing your need to re-submit each year). TO: ThompsonBaker Agency, Inc Date:* MM DD YYYY From:*Phone:*Email:* Please complete this form in its entirety to receive proof of insurance. Please utilize Form for Unit Owners proof of insurance on Master Condo Associations. This can be requested by either the Unit Owner directly or by the Lender directly. A Lender can only request a Certificate of Insurance on a unit that they have an insurable interest in or one that they are actively securing a loan for the purchase of the unit they are requesting proof of insurance on. Please note that no other proof of insurance questionnaires or loan tools will be completed by ThompsonBaker Agency and the Certificate of Insurance or Flood Declarations Page are the only documents that we will provide as proof of coverage for our Master Condo Association policies. We are unable to further assist in the loan process. Unit information: Unit owner/buyer’s name(s):*Unit #*Condominium Association*Address*Certificate holder (bank/lender) information: Name*Address*Loan #* Condo Unit Certificates must be emailed. Please provide an email address. Our new system will email the current certificate and will AUTOMATICALLY email the renewal Certificate of Insurance for this same unit on the renewal date of the policy to the email provided. This will dramtically cut down on the need for you to request the certificate again next year and every year following. The system does not work with fax numbers. Email Address for delivery of certificate of insurance:*Additional Information/ requestsCertificates are processed in 24 hours, in the order in which they are received.Insurance • Risk Managers • Financial Services 61 Cordova St., PO Box 3807, St. Augustine, FL 320853807 Telephone: (904) 824-1631 www.thompsonbaker.com This iframe contains the logic required to handle AJAX powered Gravity Forms.