Liability Insurance Application Form

Certificate of Insurance - $1M Liability

Note: This insurance is applicable only if the college will be sued by a location owner to obtain major damages. The deductible is $5,000. This is NOT for regular damage caused.
Student Full Name

First NameLast Name
Email Username
Username ONLY - Full email addresses will be rejected.
Select Domain
Calculation
Insured Location Information:
Full Name

First Name or Name of EntityLast Name
Street Address
City
ZIP
Kind of Location:
Should be Empty:

Certificate of Insurance - $1M Liability