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How to Contact Us:
 
B&B Coverage LLC
1 East Lincoln Ave,
P.O. Box 1210
Valley Stream, NY 11582

Phone: (516) 872-2300
Fax:     
Email: info@BBCoverage.com
 
Certificate Request
Please complete the form below. We will contact you for any additional information required to complete your request. Please note that no changes to your policy will take effect until you receive a confirmation from us.

Please note that fields with an asterisk (*) are required.
  I. Please Identify Yourself
Name* 
Insured* 
Insured shown 
on certificate* 
Phone*  
Cell  
Fax Number  
Email* 
 
  II. Certificate Holder
Name to 
appear* 
Address* 
City* 
State*  Zip Code  -
Fax 
Email* 
Check all that 
apply 		Additional insuredMortgagee
 Loss payee
If add'tl insured 
reason added 
 
  III. First Additional interest
Name to 
appear 
Address 
City 
State  Zip Code  -
Fax 
Email 
Check all that 
apply 		Additional insuredMortgagee
 Loss payee
If add'tl insured 
reason added 
 
  IV. Second Additional Interest
Name to 
appear 
Address 
City 
State  Zip Code  -
Fax 
Email 
Check all that 
apply 		Additional insuredMortgagee
 Loss payee
If add'tl insured 
reason added 
 
  V. Indicate specific property this applies to
Vehicle 
Equipment 
Property location 
Job 
Other 
 
  VI. Policies to be shown
Policies to be 
shown 		General LiabilityAutomobile
 UmbrellaProperty
 Workers Compensation
 
  VII. Document Deliveries
Deliver to* 
Deliver by* 
 
  VIII. Special Instructions
Quotes:
Personal insurance
Commercial insurance
Life/Health insurance
Current Clients:
Commercial policy
change
Personal policy change
Certificates of
insurance
General policy request
Claims Information
 
Copyright 2009 B&B Coverage LLC
Tel: (516) 872-2300    info@BBCoverage.com