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Certificate of Insurance Request

General Information
Name of Insured*
Name or Company of Certificate Holder
Job Reference Number
Address of Holder
Street Address Address Line 2 City State ZIP Code
Holder Phone
Holder Fax
Your Name*
Contact Email*
Handling Method
- Fax
- Email
Required Coverages
Please Provide Copy of Insurance Requirements of Contract
- Auto
- Umbrella
- General Liability
- Equipment
- Workers' Compensation
- Builders Risk
General Liability Description
Need Endorsements for Waiver of Subrogation?
- Yes
- No
Need Endorsements for Primary Wording?
- Yes
- No
Loss Payee
- Yes
- No
Mortgagee
- Yes
- No
Additional Insured
- Yes
- No
Comments or Other Instructions
Attach File(s)
Drop files here or

Max. file size: 59 MB.
Please attach written request(s) and/or contracts received, if any.
Name
This field is for validation purposes and should be left unchanged.

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Hanover Office

Miller Hanover Insurance Agency

334 High Street
Hanover, Pennsylvania 17331

Mailing Address
P.O. Box 336
Hanover, Pennsylvania 17331

Phone: (717) 637-9265

Fax: (717) 637-2454

Mon: 8:30am-7:00pm
Tue-Wed: 8:30am-5:30pm
Thu: 8:30am-7:00pm
Fri: 8:30am-5:30pm
Sat-Sun: Closed

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New Oxford Office

Miller Hanover Insurance Agency

410 Lincoln Way East
New Oxford, Pennsylvania 17350

Phone: (717) 624-8184

Fax: (717) 624-9077

Mon: 8:30am-5:30pm
Tue: 8:30am-7:00pm
Wed-Fri: 8:30am-5:30pm
Sat-Sun: Closed

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Miller Hanover Insurance Agency specializes in auto insurance, home insurance, business insurance, and life insurance for all of Pennsylvania, including Hanover, New Oxford, and Spring Grove.

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