Proof of Insurance Certificate

Paychex Insurance Agency provides you with a quick, easy method to obtain a Certificate of Proof of Insurance on our site.

If you are a Paychex Insurance Agency customer, please fill out the requested information below to request a certificate of insurance.

If you are a Travelers insurance customer, click here
If you are a Hartford insurance customer, click here

Does this require a Waiver of Subrogation?*
i.e (MM/DD/YYYY)
i.e (MM/DD/YYYY)
Is this a Contract Requirement
Is other work being done around your Employees?
Is the job payroll already accounted for on the policy?
During the policy term, will work be performed by the insured for other companies besides the certificate holder?
Type of Certificate

Policy Holder

Please fill out the requested information below. In order to fulfill this request all required fields below need to be completed.

1. Certificate Holder

Do We Need to List Additional Insureds?
Do You Have a Written Contract with the Certificate Holder?

2. Certificate Holder

Do We Need to List Additional Insureds?
Do You Have a Written Contract with the Certificate Holder?

3. Certificate Holder

Do We Need to List Additional Insureds?
Do You Have a Written Contract with the Certificate Holder?

4. Certificate Holder

Do We Need to List Additional Insureds?
Do You Have a Written Contract with the Certificate Holder?

5. Certificate Holder

Do We Need to List Additional Insureds?
Do You Have a Written Contract with the Certificate Holder?

Certificate Delivery

Send Certificate Via
Send Certificate To

File Attachments

Maximum 3 files.
256 MB limit.
Allowed types: pdf doc docx.
* The need for a waiver may add premium to your policy. The cost of the waiver will be determined by the insurance carrier at the time of endorsement.