Request for Certificate of Insurance

Request for Certificate of Insurance

WBCCI maintains a comprehensive general liability insurance policy to cover club functions and activities in the United States and Canada. The policy is provided to protect all Club, Region, International Officers, Caravan Leaders, members/agents, as well as employees, while engaged in official authorized business for WBCCI and the facilities being used or leased for official functions. It covers claims which may be brought against members/agents and employees because of accidents due to their negligence or assumed negligence.
Name of Rally/Event*
Rally/Event Location*
Address of Rally/Event Location*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Contact for Venue/Rally/Event Site*
Phone Number
Please enter a valid phone number.
Email
example@example.com
Beginning Date of Rally/Event*

MonthDayYear
Date
Ending Date of Rally Event*

MonthDayYear
Date
Special Request/Requirements from Venue/Rally/Event Site

Cancelof
Name of person submitting this form*

First NameLast Name
Email of submitter*
example@example.com
The Insurance company will be notified of the request. Once the request is processed a copy will be forwarded to the event coordinator and the venue will receive the original from the insurance company. The process normally takes 1 to 2 business days.
Should be Empty: