Insurance Certificate Request Form
Please attach any pertinent information regarding fundraising activities (brochure, advertisement, specific details)
Note: If the event involves any of the following, please contact Jina Doyle at email@example.com or 260-673-1127 immediately, as the policy either specificallyEXCLUDES coverage for these events or requires the U.S. Program to meet certain underwriting requirements. Coverage is not provided for the following activities unless approved in advance by the Insurer.
*ADDITIONAL INSURED STATUS SHOULD BE PROVIDED ONLY IF IT IS A REQUIREMENT OF THE CERTIFICATE HOLDER.
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