PROTECTING YOUR BUSINESS TODAY, INVESTING IN YOUR FUTURE

 

When you choose Wharton/Lyon & Lyon as your insurance broker, you not only make a sound investment in the immediate security of your company or organization, you make an investment in its future success as well.  We are committed to helping clients achieve their long-term financial goals and plans for growth.  So great is our commitment that many clients consider us business partners.  And that is exactly how it should be.  Because how well we manage your risks has a profound impact on your profitability and your ability to achieve certain goals.

Wharton/Lyon & Lyon has put its skills to work for thousands of clients ranging from financial institutions, schools, manufacturers and service industries to non-profit organizations, contractors, wholesalers and retailers.  Contact Wharton/Lyon & Lyon today.

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Certificate of Insurance Request

Named Insured
Account Name:
Address 1:
Address 2:
City:
State:
Zip Code:
Requested by:
enter your name
Requestors Email Address:
Requestors Phone Number:
Requestors Fax Number:
Certificate Holder
Name:
Address 1:
Address 2:
City:
State:
Zip Code:
Delivery Information
Delivery Method (Please select one) Fax  Email
Email Address:
Fax Number:
Attention to:
Required Coverage Information
(*) please provide description below
  Limit Required: Add'l Insured: Add'l Information
General Liability: (*)
Automobile Liability: (*)
Automobile Physical Damage: (*)
Propert/Contents: (*)
Equipment: (*)
Umbrella: (*)
Workers Compensation:
Other:
Required Coverage information description
Please enter description from selections above.
Description:
Additional Insured:
please select one
GL  Auto
Describe Interest of Certificate Holder
Select Interest Type Loss Payee  Mortgagee
Special Instructions:
Please Select: Primary  Non-Contributory
Waiver of Subrogation: GL  Auto  Workers' Comp
Cancellation: Yes  No
If Cancellation (please specify):
Other (please specify):
Certificate Information
Description of Operations:
Insuror Letter:
Cancellation Days:
Additional Information
Your Email Address:
Additional Notes:
* = Required Field
Attention: Please FAX or EMAIL a copy of the contract and insurance requirments to our office. - Select LOCATIONS under WHO WE ARE on our menu for the appropriate contact information.