JOSEPH E. SCHINDLER INSURANCE AGENCY
One Wall Street
Burlington, MA. 01803
Phone 781.272.7505
CERTIFICATE OF INSURANCE
INSURED'S INFORMATION
Company Name
Address
City
State
Zip Code
CONTACT INFORMATION
Contact Name
E-mail
Phone
Fax
COVERAGE'S TO BE LISTED ON CERTIFICATE
General Liability
Auto Liability
Workers' Comp
Umbrella Liability
CERTIFICATE OF HOLDER INFORMATION
Company Name
Address
City
State
Zip Code
Contact
Phone
Fax
Relationship
Select Relationship
Additional Insured
Loss Payee
Mortgagee
Leinholder
ADDITIONAL INFORMATION
Send Certificate by
Mail
Fax
How do you wish to receive receipt of delivery?
Mail
Fax
Please provide additional instructions or comments.
