Rental Vehicle Certificate Insurance Request

Requires 24 hours notice to obtain insurance certificates

Your Name(Required)
MM slash DD slash YYYY
MM slash DD slash YYYY
If rental is 6 months or more, you will be billed for the entire policy year
Garaged Address(Required)

Vehicle Information:

If the Rental Company does not know the exact vehicle that will be leased, obtain the detailed information on any comparable vehicle and the certificate will read coverage for “any substitute vehicle”
This information is:(Required)

Rental Company Contact Information:

Contact Name

  • If rental is 6 months or more, you will be billed for the entire policy year.
  • The following physical damage coverage is subject to comprehensive $100.00 deductible and collision $500.00 deductible for vehicles valued under $75,000.00. Higher deductibles apply if vehicle is valued more than $75,000.00.
  • There will be an insurance premium charge to your department for the rental, if the rental is over 30 days, or if the vehicle replacement value is over $40,000 for private passenger, and over $60,000 for a truck or if the gross vehicle weight (gvw) is over 10,000 pounds. Any premium charge will be billed at renewal in July.
  • When picking up rental vehicles, Inspect the vehicle for prior damage and notify rental company.
  • When returning the vehicle, conduct a full inspection with rental personnel to identify any potential damage
Contact IRM  or call (919) 515-6135 with any questions.
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