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AIM, Inc. dba Associated Insurance Managers
7025 Longley Lane, #60
Reno, NV 89523
 Toll Free: 877-447-1400
 Telephone: 775-827-1400
 Fax: 775-827-1501

AIM, Inc. dba Almanor Insurance Services
Lake Almanor/Northern, CA
 Toll Free: 877-447-1400
 Telephone: 530-259-2186
 Fax: 775-827-1501
 Certificate of Insurance 
Certificate of Insurance

Insured Information
Insured Name:
Policy Number:
Insured Phone Number:
Certificate Information
Name of Company or Certificate Holder:
Job Reference Number:
Certificate Holder Street Address:
City:
State: Zip:
Certificate Holder Email Address:
Certificate Holder Fax:
(include area code)
Requesters Information
Your Name:
Contact Email Address:
Handling Method:
(if other, please describe in comments area below)
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
Additional Insured:
Yes No
Loss Payee:
Yes No
Mortgagee:
Yes No
Comments or Other Instructions

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