Whenever you have a request from an outside organization for proof of insurance you need to complete the form below. When you have completed the request form click the submit button. The original letter or insurance certificate will be mailed to the requesting organization. A copy will be emailed to you as well. If the request is part of an agreement, then we will need a copy of the agreement, in addition to this request. Please email the information to our general mailbox at firstname.lastname@example.org. Make sure you reference the request details so it can be matched with the previously submitted form.
If you have any additional information you would like us to review, If you have any questions, call our office at 702-799-6496 ext. 5634.