Home About Us Personal Protection Business Protection Life, Health and Disability Financial Services Service Center Request A Quote Contact Us 6031 Cleveland Avenue Columbus, OH 43231 614-895-3131 614-895-0847 (fax) iua@iuainc.com      Request a Certificate of Insurance We're glad to help you with your request for a Certificate of Insurance! Instructions: Please complete the information below to help us process your request. Using the options at the end of the form, you may want to print a copy of this form before you submit it to us. We will contact you as needed to process your request. We will email or call you to inform you that your request has been completed. Contact Information Name Daytime Phone Evening Phone Email Name of Insured (as printed on Policy Declarations) Certificate Information Name of Certificate Holder Attention Address Additional Coverage Needed? No    Yes - We'll contact you to discuss your needs Is a License or Permit Bond Required? No    Yes - Please specify limit amount $ Special Language Requirements or Instructions Regarding This Certificate Date Needed Reason for Request   ID Number Mortgage / Lender Landlord Equipment Lease Auto Lease Job / Project Other - Please specify Send Original Certificate To Certificate Holder Insured Other - Please specify Fax Certificate To   Fax Number Certificate Holder Insured Other - Please specify Call You For Instructions? No    Yes - We'll contact you to discuss delivery details. Comments We cannot bind coverage from an email or voicemail request. Coverage is bound after you receive a written email or telephone confirmation from an Insurance Unlimited representative. Feel free to give us a call if you have any questions or need to talk with us before we are able to reply to you. Thank you for contacting Insurance Unlimited. We work for YOU!