Property & Casualty
Coverage & Markets
Additional Insured Request
Additional Insured Request Form
Additional Insured Address:
What is the description of operations of the Additional Insured?
Exact description of work Insured will be doing for the certificate holder:
Type of work:
Commercial & Residential Work
If it is Residential Work, is the Insured working on any new residential homes, tracts, condos, townhomes or apartments?
Number of Units:
Does Certificate Holder require 30 days notice of cancellation?
Does Certificate Holder require "endeavor to" wording crossed out?
Is Primary Wording required?
Is Non-Contributory Wording required?
Is the CG 20 10 11/85 edition date required?
(This endorsement can only be considered if required by contract.)
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