December 11, 2017
SAIF

Certificate of Insurance

School District
School District Name:
Certificate Holder Name:
Address:
City:
State:
Zip Code:
Phone:
Coverages Requested: General Liability
Auto Liability
Excess Liability
Property/Auto Phus Damage (please state value below)
Workers' Compensation
School Leaders Professional Liability
Other
Add Certificate of Insurance Holder as: Additional Insured
Loss Payee
Description: (Include purpose of certificate)
Questions/Comments:
Requested By:
Email:
* = Required Field
Attention: Please FAX or EMAIL a copy of the contract and insurance requirments to our office. - Select LOCATIONS under WHO WE ARE on our menu for the appropriate contact information.