Full name of the Organization requesting Proof of Insurance: Name of Contact person: Full Address: E-mail Address: Phone Number for Contact Person: FAX # where certificate will be forwarded: Additional Comments/Requirements:

Many of our customers require that a Certificate of Insurance be provided by all of their vendors. Should your organization require such proof of insurance from CES, you may request a certificate as follows: For each option, please make sure to include the following or your process will not be completed: Full name of the organization requesting proof of insurance. Full address. Name of a contact person. Fax # where certificate will be forwarded. Please fax your request to 561-354+2731, or fill in the form above.