541.536.1718 -or- 800.506.1718

La Pine Insurance Center – Request An Insurance Certificate

Please fill out the form below to request a Certificate of Insurance.

If someone has not contacted you within 1 business day regarding your certificate please call our office.

This in no way asserts or maintains that there is coverage available on your policy, that the certificate is acceptable by the insurer, or places a binder on any such coverage.


Current Insurance Information


Certificate Recipient Information


Additional Comments

La Pine Insurance Center

Phone: 541-536-1718 | Toll Free: 800-506-1718 | Fax: 541-536-5032