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Certificate of Insurance Information Form

October 12, 2020 @ 8:00 am - June 30, 2023 @ 5:00 pm


Certificate of Insurance Information Form

Please provide the information necessary to complete a Certificate of Insurance for your Event.
  • Contact Information

  • Certificate Information

  • The name of the ORGANIZATION who is requesting the Certificate of Insurance from you.
  • Complete the address of the ORGANIZATION who is requesting the Certificate of Insurance from you. A PO Box is not acceptable.
  • Please provide the name of your event.
  • Identify the name/location of where the event is being held. If may not be the same address of the ORGANIZATION requesting the Certificate of Insurance.
  • Start and End date may be the same, but both Start and End Date must be completed.
    MM slash DD slash YYYY
  • Start and End date may be the same, but both Start and End Date must be completed.
  • :
  • :
  • Provide a VERY BRIEF description of your event.
  • If your Certificate Holder has additional information that they want included in your Certificate of Insurance, please upload here! Maximum File Size is 32MB.
    Drop files here or
    Max. file size: 32 MB, Max. files: 3.

    Details

    Start:
    October 12, 2020 @ 8:00 am
    End:
    June 30, 2023 @ 5:00 pm

    Organizer

    District 7505 Office
    Phone:
    (856) 205-9600
    Email:
    office@rotarydistrict7505.org
    Website:
    www.rotarydistrict7505.org

    Details

    Start:
    October 12, 2020 @ 8:00 am
    End:
    June 30, 2023 @ 5:00 pm

    Organizer

    District 7505 Office
    Phone:
    (856) 205-9600
    Email:
    office@rotarydistrict7505.org
    Website:
    www.rotarydistrict7505.org