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We are not affiliated with MGA Insurance Company
(a subsidiary of Gainsco)

 
Commercial Claims
 Mildred Benjamin
 Phone: 708-223-1122
 Fax: 708-223-1130
 mbenjamin@mgainsurance.com
Personal Claims
 Barbara Elvart
 Phone: 708-223-1123
 Fax: 708-223-1130
 belvart@mgainsurance.com
Certificate of Insurance / Evidence of Insurance
 To request a Certificate of Insurance use one of the methods below:

 
Client Information
Client or Company Name:
Contact Name:
Phone:
Fax:
Email:
Red fields are required!



Recipient Information
Please issue Certificate of Insurance to the following:
Name:
Address:
City, State Zip: ,  
Attention:
Job Reference:
Job City, Sate , 
Do you want Certificate faxed?
Fax:



Certificate Information
Additional Interest:
Mortgagee Loss Payee Certificate Holder
If Other Please Explain:
Auto Property Inland Marine
Additional Insureds:
Certificate Holder
If Other Please Explain:
Primary Non-Contributory
General Liability Auto Excess/Umbrella
Waiver of Subrogation: General Liability   Workers' Comp.



 
Special Instructions
Please give any special instructions you feel appropriate for this certificate.


 

 
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