Allen Financial Insurance Group

Certificate of Insurance / Additional Insured Endorsement Request

 Certificate Information

I/We hereby make reqiest for activity or event shown above.  I/We understand and agree that this request shall form part of any policy issued or in effect and that the Company requires that I/We obtain certificates of insurance from independent contractors.  

I/We agree that, if this application is sent to you by facsimile or other electronic means, you may act upon it whether or not you receive an original hard copy.  Coverage is not provided for events, activities or show dates that have not been declared and approved by the insurance company in writing prior to of the event.

FRAUD WARNING: Any  person who knowingly and with intent to defraud any insurance company or other person files an application for insurance containing false information or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act which is a crime.


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