Certificate of Insurance Request Form: Swim Alberta Association

LloydSadd Brokers
This form is only used if a facility requests to be named on the Certificate of Insurance.
Please allow three weeks prior to your event for processing time.  Thank you.
Club Information:
Details of Event (What are you doing?  Where are you going?  Who's attending?)
Requesting Facility Information

This information will be listed on the Certificate of Insurance.  Please provide accurate and exact information.

A scan of your contract MUST be included with this form.
dd/mm/yyyy