Home
Insurance
Performer
Online Application Form
Certificate Request
Vendor
Online Application Form
Certificate Request
Health Insurance
Special Event Insurance
Safety
Client
Client Testimonials
Client Photos
About Us
Contact Us
Performer Certificate
Insured's First Name
*
Please use proper name capitalization.
Middle Initial
Insured's Last Name
*
Business or Performer Name
Insured's Email
*
Please type only one email.
Certificate Holder
Venue where you are performing
Additional Insured Name: (Venue that is asking for certificate)
*
Attention (contact person)
Address
*
City
*
State
*
Please Enter State Abbreviation Ex: Florida = FL
Zip Code
*
Additional Insured: (special language may be required - read your contract)
Attach A File
Attach a File (Insurance Guidelines, Sample Certificates, Venue Information)
Files must be less than
6 MB
.
Allowed file types:
txt doc docx xls xlsx pdf jpg jpeg gif png
.
Email For Event
Fax Number For Event
Format: xxx-xxx-xxxx
Event Date(s)
*
Date Needed - Click in box for popup calendar
*
Date
E.g., 2019-02-21
Additional Email
Process ASAP
Vertical Tabs
Printer-friendly version
