Mesa, AZ · Maricopa County
Certificate of Insurance
This certificate records an insured party’s coverage details for the City of Mesa and is completed by an authorized insurance company representative.
What this form is
The certificate lists the insured party, insurer, policy numbers and periods, and actual liability limits compared with the minimum coverage shown. It describes coverage requirements for work involving the City, including right-of-way permits and certain construction projects. The certificate states that the City must be named as an additional insured for covered work, except for workers’ compensation, and requires an authorized insurance company representative’s signature.
Who needs it
An insured party whose work requires insurance documentation for the City of Mesa needs an authorized insurance company representative to complete this certificate.
How to submit it
Send the certificate to Development Services, City of Mesa, P.O. Box 1466, Mesa, AZ 85211-1466.
About notarization
This certificate is signed and dated without a notary; the form requires an authorized insurance company representative to sign and does not mention a notarized attachment.
How to submit this form
- 1
Download The Certificate
Download the City of Mesa Certificate of Insurance PDF.
- 2
Complete The Coverage Details
Provide the insured party’s name and address, insurer, policy numbers, policy periods, and actual liability limits.
- 3
Get An Authorized Signature
Have an authorized representative of the insurance company sign and date the certificate.
- 4
Send It To Development Services
Send the certificate to Development Services, City of Mesa, P.O. Box 1466, Mesa, AZ 85211-1466.
Frequently asked questions
- Do I need a notary for the Certificate of Insurance?
- No. This certificate is signed and dated without a notary; it requires an authorized insurance company representative’s signature and mentions no notarized attachment.
- How do I submit the Certificate of Insurance?
- Send the certificate to Development Services, City of Mesa, P.O. Box 1466, Mesa, AZ 85211-1466.
- Who completes the Certificate of Insurance?
- The certificate records the insured party’s coverage details and must be signed by an authorized representative of the insurance company.
Need something notarized?
This Certificate of Insurance doesn’t need a notary — but if you have another Mesa form that does, a commissioned online notary can help.