COI - Certificate of Insurance

This is the form to request a Certificate of Insurance (COI) from Delivery Companies being used by Jensen-Lewis.

Please let us know all details so that the certificate can be filled out correctly. If you have questions, please contact us.

Your Information

Name

Phone Number

Delivery Date Order Number Customer Name Delivery Address Apartment/Suite Number Delivery City Delivery State Delivery Zipcode Receiving Hours

Building/Corp. Name Address City State Zipcode Building Manager Name Building Manager Email Building Manager Fax Building Manager Phone

Additional Insured Comments