COI Request Form - Cornerstone Staffing Solutions, Inc.

Instructions: 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.

Comments
This field is for validation purposes and should be left unchanged.
Certificate of Insurance Request Form
Certificate Required By*
Requestor Information
Requestor Name*
Email*
Branch Name
Branch Contact Name*
Enter the name of the Branch Contact if we have any questions.
Named Insured*
Certificate Holder Information
Customer Name*
Customer ID*
Avionté Customer ID
Customer Address*
Street Address City State / Province / Region ZIP / Postal Code
Phone
Fax
Attention
Distribution Method*
Customer Email*
Customer Fax*
Customer Address
(Enter address if different from above.)

Street Address City State / Province / Region ZIP / Postal Code
Document and/or Sample COI from Customer
Drop files here or

Max. file size: 100 MB.
If the Customer has provided a sample COI or additional information with insurance requirements, please upload.
Special Instructions
Please include any special instructions provided by the Customer.

Certificate of Insurance Request Form

Requestor Information

Certificate Holder Information