If you have received a letter requesting a Certificate of Insurance from your bank or
mortgage company, you may forward or fax said letter, in lieu of filling out this form to:
Private Client Insurance
9736 Commerce Center Court
Ft. Myers, FL  33908

ATTENTION:    Laura Bristol

or FAX to:     (239)481-2911
REQUEST FOR CERTIFICATE OF INSURANCE
PROPERTY & FLOOD INSURANCE
CLIENT CODE:        SORRENTO AT THE COLONY – BONITA SPRINGS, FL
Unit #
 ADDRESS: 23650 Via Veneto     Bonita Springs, Florida 34134
Owners name:
Loan Number:
Lender / Bank Name:
Address:
City,State,Zip
Phone Number:
Fax Number:
Contact's name:
Comments:
This form will be electronically sent to the Sorrento office where the certificate of
insurance will be ordered from Specialty Risk Management Services.  A confirmation
email will be sent upon the order being placed.