Sample Certificate of Insurance—3 Request Templates

Use this sample certificate of insurance template when a client, contractor, landlord, vendor, or lender asks your agency for a COI and your CSR needs complete details before starting the certificate. This page gives you 3 COI request templates, a worked intake example, and a 12-point checklist to collect holder details before a CSR starts. A sample certificate of insurance template is a reusable intake script that collects the information needed to issue or route a COI accurately; it is not a substitute for the approved certificate form your agency uses.

If you need a blank certificate form, obtain the current approved form through ACORD, your management system, carrier, or authorized form provider; the templates here are for collecting the request.

TL;DR: Use the templates below to collect the certificate holder, job or contract details, delivery email, deadline, and endorsement requests before a CSR starts the certificate. If the request includes additional insured, waiver of subrogation, primary and noncontributory wording, or unusual contract language, route it to the person your agency authorizes to review coverage and endorsement requests, often a licensed CSR, producer, or commercial-lines lead.

Key takeaways:

• A good certificate of insurance template starts with intake, not with a blank PDF.
• In the agency workflows I review, delays often begin with missing holder details, unclear project wording, or endorsement requests that were not routed correctly.
• Use ACORD 25 or your agency’s approved form for liability certificates; use this page for request intake and CSR routing.
• The requester can ask for wording, but your agency should verify it according to policy terms, carrier practice, contract requirements, and agency procedure before issuing.
• Licensing and certificate procedures vary by jurisdiction, carrier, role, and agency, so make your routing rule explicit.
• Automate the front-door capture of routine details, then route coverage and endorsement questions to a person at the agency.

What is a sample certificate of insurance template?

A sample certificate of insurance template is a reusable request format that tells the client or third party exactly what your agency needs before issuing or routing a certificate.

A lot of search results show a sample PDF. That helps someone recognize what a COI looks like. It does not solve the Tuesday afternoon agency problem: a CSR gets a voicemail that says, “Can you send a cert to my landlord?” and has to call back for the holder name, address, email, job description, deadline, and requested wording.

For an independent P&C agency, the more useful asset is usually a certificate of insurance request template. It gives your CSR the same information every time, in the same order, so the work can be reviewed without detective work.

When people search for an acord certificate of insurance template, they usually mean one of two things:

• They want to see the general layout and fields of the ACORD 25 certificate of liability insurance.
• They need a way to request certificate details before an agency issues the certificate.

If you need field-by-field help on the certificate itself, use our ACORD 25 field map and mistakes list. If you need the request language, use the copy-paste templates below.

Here is the operating distinction I recommend agency owners put in writing:

Need	Use	Do not use
Collect holder and delivery details	COI request template	A blank certificate form sent to the client
Issue evidence of liability coverage	Your approved certificate form	A homemade PDF
Understand ACORD 25 fields	ACORD 25 field map	Guesswork from a phone message
Handle additional insured or waiver requests	Agency-authorized review process	Clerical editing from a casual call

A common source of rework is that callers use “COI” to mean different things. One client means proof of insurance. Another means additional insured status. A property manager may be asking for exact contract language. Those are not the same workflow.

What does a certificate of insurance form look like?

A certificate of insurance form looks like a one-page evidence document with sections for the producer, insured, insurers, coverage lines, limits, policy dates, description of operations, and certificate holder.

The form is structured because it is summarizing existing policies. It is not where your team should improvise coverage. If your agency uses ACORD 25, the request data below usually maps into the certificate areas this way.

Certificate area	Example request data	Where the data comes from	CSR caution
Insured	Bayview Plumbing LLC	Named insured on policy	Match the policy record, not a nickname
Certificate holder	Northgate Property Management LLC, 1200 Harbor Avenue, San Mateo, CA 94401	Holder request or contract	Use the legal name and mailing address
Description of operations	Plumbing work at 500 Market Street, Suite 210	Job details from client or contract	Keep factual job details separate from coverage wording
Delivery	certs at northgatepm dot com	Requester instructions	Confirm spelling before ending the call
Special wording	Additional insured and waiver requested	Contract or holder instructions	Route under agency procedure before adding wording

This is not a completed ACORD 25, and it should not be treated as one. It is an intake map: the safe bridge between a messy call and the approved certificate workflow your agency already uses.

Copy-paste sample certificate of insurance request templates

These certificate of insurance request templates are meant to be copied into email, web forms, text replies, and CSR notes.

They are not legal advice, and they do not replace your agency’s coverage review. They are designed to make every request for certificate of insurance arrive with the same minimum facts.

Template 1: Basic COI request

Use when: a client needs evidence of insurance sent to a certificate holder, with no known special endorsement request.

Subject: Certificate of Insurance Request for [Insured Name]

Hi [Client Name],

We can help with the certificate of insurance request. Please reply with the details below so we can issue or route it correctly.

1. Named insured on the policy:
2. Certificate holder name:
3. Certificate holder mailing address:
4. Email address or fax number for delivery:
5. Job, project, event, or location this certificate is for:
6. Date the certificate is needed:
7. Do they need evidence of coverage only, or did they request special wording?
8. If special wording was requested, please attach the contract or paste the exact wording.

Once we have this information, our team will review and send the certificate or follow up if anything requires approval.

Thank you,
[Agency Name]

Template 2: Contractor or vendor certificate request

Use when: a general contractor, property manager, municipality, landlord, or vendor portal requests a COI and may require additional insured wording.

Subject: COI Request Details Needed for [Project or Holder Name]

Hi [Client Name],

To process this certificate of insurance request, please send the information below.

Insured business name:
Certificate holder legal name:
Certificate holder mailing address:
Delivery email or portal instructions:
Project name or job number:
Project address:
Work being performed:
Start date or deadline:
Required limits, if provided:
Requested wording, if provided:
Does the contract ask for additional insured status?
Does the contract ask for waiver of subrogation?
Does the contract ask for primary and noncontributory wording?
Please attach the insurance requirements page from the contract.

Important: requested wording may require review under agency procedure before we can issue the certificate with that wording.

Thank you,
[Agency Name]

Template 3: Rush COI request text message

Use when: a client texts or calls from a jobsite and needs a fast request path without losing required details.

We can help with your certificate of insurance. Please text back:

1. Your business name
2. Who the certificate should be issued to
3. Their mailing address
4. Email for delivery
5. Job or project address
6. What work you are doing
7. Any exact wording they requested
8. When you need it

If they are asking to be added as additional insured or want waiver wording, our team will need to review according to agency procedure before issuing that wording.

I like this text because it is short enough for a contractor in a truck, but it still catches the dangerous parts: special wording, additional insured requests, and waiver language.

Can you provide a worked example of a COI request?

A worked COI request example should show the exact notes a CSR needs before issuing or routing the certificate.

Here is a realistic small commercial example.

Incoming request:
Client called from jobsite. Needs COI sent today to property manager.

Named insured:
Bayview Plumbing LLC

Certificate holder:
Northgate Property Management LLC
1200 Harbor Avenue
San Mateo, CA 94401

Delivery:
certs at northgatepm dot com

Project:
Tenant improvement plumbing work at 500 Market Street, Suite 210, San Mateo, CA 94401

Work being performed:
Replace sink lines and install breakroom fixtures

Deadline:
Today by 3 PM Pacific

Special wording requested:
Property manager says they need to be additional insured and want waiver of subrogation. Client does not have the contract handy.

CSR action:
Do not issue special wording from the phone request alone. Ask client to send the contract insurance requirements. Route to the person your agency authorizes to review coverage and endorsement requests, often a licensed CSR, producer, or commercial-lines lead.

Evidence-only option:
If agency procedure permits an evidence-only certificate, make sure it accurately reflects current coverage and does not imply that requested endorsements or status have been granted. Otherwise, hold the certificate until the request is reviewed.

This is the gap I see when I review front-desk call flows with agency owners. The CSR can often move quickly on a clean evidence-only request. But the phrase “they need to be additional insured” changes the workflow.

Depending on policy terms, carrier practice, contract terms, and agency procedure, the request may require confirming whether endorsement wording is available, whether it already applies, whether the contract wording matches what can be issued, and whether there is any account action before the certificate goes out.

For related commercial intake fields outside COIs, see our ACORD Commercial Insurance Application 125 field map.

What should be on the COI request checklist?

A COI request checklist should collect the holder, delivery method, purpose, deadline, and any wording that could affect coverage or endorsement handling.

Use this 12-point checklist before a CSR starts the certificate:

• Named insured exactly as it appears on the policy
• Policy or account number, if the requester has it
• Certificate holder legal name
• Certificate holder mailing address
• Delivery email, portal, or fax instructions
• Job, project, event, or location tied to the request
• Work being performed or reason for the certificate
• Required deadline
• Coverage lines requested, such as general liability, auto, umbrella, workers compensation, or property
• Required limits, if provided by contract
• Exact special wording requested, not a paraphrase
• Contract insurance requirements attached, if additional insured, waiver, or primary wording is requested

Here is the routing rule I would put in writing. Adjust it for your state, carrier appointments, staff licenses, and internal authority.

Request detail	CSR can proceed if agency procedure allows	Route for authorized review
Evidence of current general liability limits	Yes	If policy status or limits are unclear
Certificate holder name and address	Yes	If holder asks to be named in special wording
Description of operations with factual job details	Yes	If wording may change coverage rights
Additional insured request	Not as a clerical task	Yes
Waiver of subrogation request	Not as a clerical task	Yes
Primary and noncontributory request	Not as a clerical task	Yes
Contract insurance exhibit attached	Not as a clerical task	Yes

The certificate should not be the first place your agency discovers a coverage gap. The checklist is there to slow down the risky parts while speeding up the routine parts.

How should CSRs handle a certificate of insurance request by phone?

A CSR should use a fixed phone script, confirm whether special wording is requested, and repeat the holder and delivery details before ending the call.

Here is a script your team can use as written.

Thanks, I can help get the certificate request started. I need a few details so we issue or route it correctly.

First, what is the named insured or business name on the policy?

Who should the certificate be issued to? Please give me the full legal name and mailing address.

Where should we send it when complete?

What job, project, event, or location is this for?

When do you need it?

Did they only ask for proof of insurance, or did they ask for specific wording such as additional insured, waiver of subrogation, or primary and noncontributory language?

If they requested special wording, please send us the contract or the insurance requirements page. Our team will review it under agency procedure before issuing that wording.

Let me repeat the holder name, address, delivery email, and deadline back to make sure I have them right.

Repeating the holder name and email is a simple control I recommend because it catches spelling errors while the caller is still on the line. When I review COI call flows, the repeat call is usually for one of three missing items: holder address, delivery email, or contract wording.

If interruptions are the bigger problem, pair this script with a clear queue. Our insurance CSR workflow article gives a 6-step way to reduce random desk taps and call-backs.

Where does Sera fit in a COI workflow—and where doesn’t it?

Sera fits at intake and routing; it does not issue certificates, interpret coverage, approve wording, or write back to an agency management system.

A practical COI automation setup does not need to be fancy. Start with the repeatable front-door work: answer the call, ask the required questions, capture the transcript, and send the request to the right queue. Then your CSR reviews and issues the certificate in the agency’s normal system.

Routine task	Good automation target	Keep human review for
Answering after-hours COI calls	Phone intake and transcript	Coverage interpretation
Asking the 12 checklist questions	Web chat, SMS, email, WhatsApp, or phone script	Deciding if wording is allowed
Capturing delivery email and deadline	Structured note to inbox or supported CRM destination	Prioritizing high-risk requests
Flagging words like additional insured or waiver	Escalation rule	Approving endorsement wording
Sending missed-call text-back	Follow-up prompt on Growth or above	Licensed advice
Booking a review call	Appointment booking on Growth or above	Contract review conversation

At Twig, we built Sera for this front-door work. Sera is an AI front desk for local businesses: she answers every phone call, text, web chat, email and WhatsApp message, 24/7, and books the appointment.

For an independent agency, that means Sera can answer the COI call at lunch, after hours, or while the CSR team is buried in renewals. Every conversation is logged with a full transcript, and Sera escalates to a person when the question is outside what she knows, with the conversation attached. Your agency sets the escalation rules.

There are limits, and they matter. Sera has no direct integration with EZLynx, HawkSoft, Applied Epic, AMS360, or QQCatalyst. Call notes and intake can be sent to Gmail, HubSpot, Salesforce, or Slack, but your team still completes the certificate in its normal agency workflow. Sera does not bind coverage, quote premiums, give coverage advice, or file claims with carriers. Twig is SOC 2 Type II certified, but Sera is not HIPAA compliant and Twig does not sign BAAs.

If you want to see where an AI receptionist fits for agency calls beyond COIs, start with Sera for independent insurance agencies. Sera starts at $49 per month with a 15-day free trial, voice included, and no credit card. Appointment booking, missed-call text-back, live transfers, and multilingual conversations require Growth at $499 per month or above. Most businesses can go live in under 30 minutes by forwarding a phone line or adding web chat. See Sera pricing if you are budgeting.

What is the next step for your agency?

Pick one template, put it where requests enter, and make the routing rule visible to every CSR, producer, and principal.

My suggested rollout is simple:

1. Add Template 1 to your CSR email snippets.
2. Add Template 3 to your missed-call or text reply workflow.
3. Train CSRs to flag additional insured, waiver, and primary wording for the review path your agency requires.
4. Create one shared inbox label or queue called COI Requests.
5. Audit 10 requests next Friday and count how many arrived complete.

As a starting check, review 10 requests. If fewer than 7 arrive complete, inspect the intake form or script before assuming the CSR is the bottleneck. Sometimes the issue is staffing, authority, or carrier turnaround. But in many agencies, the first fix is simpler: stop letting incomplete COI requests reach the CSR desk.