Complete the required fields below and click submit to request a certificate of insurance (COI). Once submitted, you will receive a
confirmation email when the request has been approved and submitted to the insurance company.


Once processing is complete, a hard copy of the certificate will be sent to the mailing address listed below, and an electronic version
will be sent to you, as well to the email address that you designate.


Contact David Thao in the Finance department with any questions.

Provide your Information
Provide the Customer/Vendor information as it should be printed on the certificate

A certificate of insurance is a legal document. In the fields below, enter the entity’s legal name and address as it should appear on the certificate.

Commercial General Liability Insurance amounts

The fields below are for Commercial General Liability Insurance ONLY.


If an insurance type other than Commercial General Liability is required (such as automobile or workers compensation insurance, please contact Brian Berger in person)


Enter the required amounts below. If you are unsure of the coverage amounts, contact the customer/vendor. If a certain type is not required enter zero. DO NOT USE COMMAS when entering large numbers.


The customer/vendor will receive the default amounts per the Power Products LLC insurance policy. Certificates are customarily issued with the default coverage amounts per the Power Products LLC insurance policy. If greater coverage is desired, the Finance department will issue a specific request to the insurance company.

Additional insured's

List any additional insured’s and “Doing business as” names that the customer/vendor require to be stated on the certificate.

Specific Instructions

Please use the box below to include any other additional instructions.