In navigating the intricate landscape of professional interactions within New York City, the Certification by Insurance Broker or Agent form plays a pivotal role, serving as a bridge of trust and compliance between the bustling city's administrative bodies and the professionals operating within its bounds. This document, while straightforward in its appearance, functions as a testament to the accuracy of the attached Certificate of Insurance, a crucial piece of verification in myriad commercial and professional settings. By providing a clear and concise representation, the insurance broker or agent affirms to the City of New York that the information contained within is reliable and correct, addressing all material respects. Such a declaration necessitates the broker or agent's full identification, including typewritten name, address, email, and contact numbers, cementing the form's authenticity. Moreover, the solemnization of this declaration under the watchful eye of a Notary Public, complete with official seals and signatures, underscores its importance and the gravity with which it is regarded in the professional realm. This process not only assures the city but also protects all parties involved, making the Certification by Insurance Broker or Agent form an indispensable tool in maintaining the integrity and reliability of business operations within New York City.
| Question | Answer |
|---|---|
| Form Name | Certification Broker Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | certification insurance broker agent, certification broker agent, certification broker nyc form, broker state york |
CITY OF NEW YORK
CERTIFICATION BY INSURANCE BROKER OR AGENT
The undersigned insurance broker or agent represents to the City of New York that the attached Certificate of Insurance is accurate in all material respects.
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[Name of broker or agent (typewritten)]
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[Address of broker or agent (typewritten)]
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[Email address of broker or agent (typewritten)]
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[Phone number/Fax number of broker or agent (typewritten)]
_____________________________________________________
[Signature of authorized official, broker, or agent]
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[Name and title of authorized official, broker, or agent (typewritten)]
State of ……………………….)
)ss.:
County of …………………….)
Sworn to before me this _____ day of ___________ 20___
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NOTARY PUBLIC FOR THE STATE OF ____________________