Certificate of Insurance Request Form
1430 W Herndon Ave.
Fresno, CA. 93711
Attn: Lisa Perez
Email - firstname.lastname@example.org
Request for Certificate of Insurance Checklist
No Certificate of Insurance and/or Additional Insured Endorsement will be issued until all the above information is received in our office.
- Name, mailing address, contact name of certificate holder (party requesting proof of insurance
- Copy of contract/agreement stating insurance requirements from certificate holder
(If this information is not on contract/agreement please request a copy in writing)
- Date of event
- Description of event (include organization/school participating in event)
- A two-week advance notice would be appreciated to process the paperwork.