Certificate of Insurance Request

Have you already delivered the Memorandum of Insurance (MOI) to the customer?: *

Yes

No

Please click below to access the MOI (Memorandum of Insurance) and provide to your customer

1) Send this link (http://www.marsh.com/moi?client=0894) to your customer for download

2) Access the MOI using the link and email a PDF to your customer

Additional Memorandum of Insurance (MOI) Information:

Ecolab provides proof of insurance via an electronic Memorandum of Insurance (MOI) that replaced the Certificate of Insurance and is widely accepted by Ecolab customers.

The MOI provides the same coverage information as an Acord form Certificate of Insurance and also provides others Additional Insured status automatically on a blanket basis when required by a written contract/agreement via the policy endorsements (listed on page 3&4 of the MOI). (Note: The MOI differs from an Acord form Certificate of Insurance in that the customer name/address is not entered in the Certificate Holder box, and customers access MOIs electronically directly via the broker website. All other verbiage is the same on the MOI/COI.)

Please request a Certificate of Insurance from Form Site only after presenting the customer with the electronic Memorandum of Insurance and they have rejected it.

Customers and Nalco Water employees should access the electronic Memorandum of Insurance (MOI) directly from the broker website whenever it is needed. This ensures the most up-to-date version on the date it is accessed (same website each year, with each insurance renewal on December 31.) Access to the Ecolab MOI is available 24/7/365 by accessing our broker website at http://www.marsh.com/moi?client=0894.

Copy and paste the link above in your web browser

Click on VIEW MOI
Click on I ACCEPT
Review and print a copy for your records

PLEASE PROCEEED WITH YOUR CERTIFICATE OF INSURANCE (COI) REQUEST

Your Name: *

Your Email Address: *

District: *

Request Type: *

New COI

Reprint

Change Existing

Code as Ecolab or Nalco Business: *

Ecolab

Nalco

Preferred Delivery Method to Certificate Holder: *

Email

Fax

Certificate Holder Email Address: *

Certificate Holder Fax Number: *

PLEASE NOTE THAT THE CUSTOMER CONTACT INFORMATION ENTERED BELOW WILL APPEAR AS SUCH ON THE CERTIFICATE OF INSRUANCE.

PLEASE REVIEW FOR ACCURACY PRIOR TO SUBMITTAL.

Certificate Holder Company Name: *

Address: *

City: *

State: *

Zip Code: *

Sample COI for Reference:

Special Instructions/Comments:

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