This is a certificate for Liberty Security Services’ liability insurance, for contractors, landlords and property managers who need us named on their paperwork.

If you are a customer who needs proof that your own alarm system is monitored, for a discount from your insurer, use the Alarm Insurance Certificate instead.

Before we act on this request: once this form is submitted, we contact the people on your account’s call list to verify it before any change is made. This protects your account from unauthorized changes, and it means no request is carried out on the strength of a form alone.

Certificate of Insurance Request

Certificate of Insurance Request

Your Name
Your Name
First Name
Last Name
What Is the Certificate For?
The company or person the certificate must be issued to.
Certificate Holder Mailing Address
Certificate Holder Mailing Address
City
State/Province
Zip/Postal
Country
Additional Insured
Any party that must be named as additional insured, with their full legal name and address. Leave blank if none is required.
Waiver of Subrogation Required?
Primary and Non-Contributory Required?
If the contract specifies limits, paste them here.
Wording that must appear in the description of operations box on the certificate.