Insurance Certificate

Request for Insurance Certificate
All events of the Arizona Quilters Guild are covered by AQG’s commercial general liability and business personal property insurance policy regardless of whether or not a certificate of insurance has been issued for that location or event. As such, AQG does not automatically have certificates of insurance generated for all events or locations.

However, certain locations may require certificates of insurance listing the location as an additional insured. If your location requires such a certificate, please complete and submit this form to the AQG Office.
Chapter Contact Information
Request Date

MonthDayYear
Date
Chapter*
Chapter Contact*

First NameLast Name
Chapter Contact Email*
example@example.com
Indicate your follow up preference*

Please email Chapter Contact with submission to InsuranceNo additional follow up required
Chapter Contact Phone Number*

Area CodePhone Number
Chapter Contact Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Event and Location Details
Event Type*

Chapter MeetingSpecial Chapter EventOther
Event Name
Event Date

MonthDayYear
Date
Location Address*

Facility Name

Street Address

CityState / Province

Postal / Zip Code
Location Contact Person*

First NameLast Name
Location Phone Number*

Area CodePhone Number
Location Contact Email
very useful, if you can provide it
Location Fax Number

Area CodePhone Number
Insurance Certificate Requestor: in some cases, the property owner requesting the insurance certificate is not the same as your Location Contact. For those situations, additional contact information is required.
Confirm Insurance Certificate Requestor*

Use Location Contact and Address listed aboveUse Contact and Address listed below
Requestor Name

First NameLast Name
Requestor Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What happens next?
1. Please print a copy of this Request Form for your records (right button below) before you submit (left button below).
2. You should recieve an automatic email confirmation very soon after you submit the Request.
3. A Board member will submit your Request to the AQG Insurance Agent. If you wish to know when your request has been submitted, select the email as your follow-up preference (above).
4. The AQG Insurance Agent will send the certificate to the location requiring the certificate. If you included a Location Fax Number (above) for the entity requesting the certificate, it will be faxed directly to the entity by the insurance company.
If you have any questions, contact president@aqgmail.org
Should be Empty:

Request for Insurance Certificate

Chapter Contact Information

Event and Location Details