Additional Insured Info Request
Please provide the following for each Additional Insured:
Please check off which of the following apply as to their interest:
[ ] Loss Payee [ ] Mortgagee [ ] Additional Interest [ ] Certificate Holder
Name:
Address:
Fax & Contact Name:
Email & Contact Name:
Phone & Contact Name:
It is very important for you to review your contracts to see if you are required to have any of the following additional coverages for the additional insured:
Waiver of Subrogation
Primary non-contributory wording
They are not normally included in additional insured coverage but are often available for an additional premium as they change the risk.
Sincerely,
<<User Name>>
<<Agncy_Name>>
<<Agncy_Address>>, <<Agncy_City>>, <<Agncy_State>> <<Agncy_Zip>>
Phone:<<Agncy_Phone>> | Fax: <<Agncy_Fax>>