Get the free Certificate Holder/Additional Insured Request Form - AIM ...

Certificate Holder/Additional Insured Request Form Insured Information (please print or type and fax to 214-360-0802) Organization Name Insured Number Address City / State / Zip Board Member Name

How to fill out certificate holderadditional insured request

How to fill out a Certificate Holder/Additional Insured Request:

1. Obtain the necessary form: Start by obtaining the Certificate Holder/Additional Insured Request form. This form can generally be obtained from your insurance provider or the entity requesting to be named as a Certificate Holder or Additional Insured.
2. Fill in your information: Begin by filling in your own information as the policyholder. This includes your name, contact information, and any identifying numbers or codes related to your insurance policy.
3. Provide the entity's information: Input the name, address, and any other required details of the entity that is requesting to be named as a Certificate Holder or Additional Insured. This could be a client, partner, vendor, landlord, or any other relevant party.
4. Specify the coverage requirements: Clearly indicate the specific insurance coverages that the entity is requesting to be listed for. This could include general liability insurance, professional liability insurance, auto insurance, workers' compensation, or any other relevant coverage types.
5. Attach supporting documents: If the entity requesting to be named as a Certificate Holder or Additional Insured has provided any specific documentation or contracts requiring this endorsement, be sure to attach them along with the Certificate Holder/Additional Insured Request form. This will help ensure accuracy and compliance with their requirements.
6. Review and sign: Before submitting the form, carefully review all the information provided for accuracy. Once satisfied, sign and date the form to certify that the information provided is true and complete.

Who needs a Certificate Holder/Additional Insured Request?

1. Contractors and subcontractors: Construction companies and contractors often need to provide proof of insurance coverage to their clients, landlords, or project owners. These parties may request to be named as Certificate Holders or Additional Insureds to protect their interests in case of accidents or liabilities related to the project.
2. Event organizers: When organizing large events, such as concerts, conferences, or trade shows, event organizers may require vendors, performers, or exhibitors to name them as Certificate Holders or Additional Insureds. This ensures that they are protected against any potential claims or lawsuits arising from the event.
3. Property owners and property management companies: Property owners or managers may request to be named as Certificate Holders or Additional Insureds by their tenants, contractors, or maintenance service providers. This helps protect their property and investments in case of any potential damages or liabilities caused by these parties.

In summary, filling out a Certificate Holder/Additional Insured Request involves obtaining the form, providing the required information of the policyholder and the requesting entity, specifying the coverage requirements, attaching any supporting documents, reviewing and signing the form. Various industries and situations may require a Certificate Holder/Additional Insured Request, including contractors, event organizers, and property owners or managers.

For pdfFiller’s FAQs

What is certificate holder additional insured request?

Certificate holder additional insured request is a request made by the entity or individual holding a certificate of insurance to be named as an additional insured on the policy.

Who is required to file certificate holder additional insured request?

The entity or individual requesting to be named as an additional insured on the policy is required to file the certificate holder additional insured request.

How to fill out certificate holder additional insured request?

The certificate holder additional insured request form must be filled out with the necessary information and submitted to the insurance provider for processing.

What is the purpose of certificate holder additional insured request?

The purpose of certificate holder additional insured request is to provide added protection to the entity or individual holding the certificate of insurance by being named as an additional insured on the policy.

What information must be reported on certificate holder additional insured request?

The certificate holder additional insured request must include the name of the entity or individual requesting additional insured status, the policy number, and any specific coverage requirements.

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