Certificate of Insurance Request Form 1. Fill out the form and submit. Red asterisk indicates required information, which must be completed before the request can be processed. 2. Please ensure the fully executed agreement (i.e., signed by client and CSSI) is uploaded into Avionté, so insurance requirements can be verified. If the Agreement has not been uploaded, it will delay the request. 3. Upon receipt, please upload the Certificate of Insurance into the Documents section in the Customer file in Avionté. Certificate of Insurance Request FormCertificate Required By*Standard (24 hours)RushRequestor InformationName*Email* Branch NameBranch Contact*Named Insured*Cornerstone Staffing Solutions, Inc.Cornerstone Staffing Solutions, Inc. dba Arlington ResourcesCornerstone Staffing Solutions, Inc. dba Casey Accounting & Finance ResourcesCornerstone Staffing Solutions, Inc. dba RightStoneCertificate Holder InformationCustomer Name*Customer ID*Customer Address* Street Address City State / Province / Region ZIP / Postal Code PhoneFaxAttentionDistribution Method*Email to requestorEmail to customerFax to requestorFax to customerMail to requestorMail to customerCustomer Email*Customer Fax*Customer Address(Enter address if different from above.) Street Address City State / Province / Region ZIP / Postal Code Special InstructionsCommentsThis field is for validation purposes and should be left unchanged.