Certificate Request – Insurevents

Certificate of Insurance Request For An Existing Client

Policyholder Information
Policy Number*
Company Name
Please, do not type in ALL CAPS anywhere on this form.
Your Full Name*
Phone Number*
Email (If you are an insurance broker, use your email & not your clients)*
Event Information
Name of Event or Description*
Budget*
Your cost to produce, promote, or attend this event.
Event Dates*
First Date of Load In*
MM slash DD slash YYYY
Last Date You Load Out*
MM slash DD slash YYYY
Event Hours*
Estimated Attendance (All Days). For Vendors, indicate estimated attendance at your booth(s)*

For example: 500 attendance on Friday, 1,000 attendance on Saturday and 1,000 attendance on Sunday would be a total of 2,500 attendance, even if it's the same persons each day.
Name of Venue (Or the company requiring you to have this insurance - check your contract if unsure.)*
Mailing Address*
Location Mailing Address City State / Province / Region ZIP / Postal Code Country
Telephone
Fax
Contact's First & Last name*
Contact's Email
Venue's/additional insured wording (found in your rental agreement)
Does the contract require a Primary & Noncontributory endorsement?*
Higher rates apply if you need it.
- Yes
- No
Does the contract require a Waiver of Subrogation endorsement?*
Higher rates apply if you need it.
- Yes
- No
Any additional information we need to know?
Upload a copy of your venue agreement or any other documents you wish us to review.
Acceptable file types: pdf, jpg, gif, png, doc, docx, xls, xlsx. Maximum File Size: 128MB.
Drop files here or

Accepted file types: pdf, jpg, gif, png, doc, docx, xls, xlsx, Max. file size: 256 MB.
If you have additional certificates of insurance you need to request, after submitting this one, use your browser's back button - then update the information for your next request and click submit. Repeat as many times as necessary.
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Certificate of Insurance Request For An Existing Client

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