To request a certificate of insurance, please complete and submit the following information. Your request will go to the Executive Director for review and response.

If you have questions, please contact the Executive Director at ED@harmonyinc.org or the corporate office at 1-855-750-3341.

Note on requests for Additional Insured (as of 2024)

Due to changes in state law, the insurance issuer can no longer list the names of Additional Insured parties on Certificates of Insurance. The certificate issued by the insurance company will provide Additional Insured status under the GL, Auto and Umbrella policies and Waiver of Subrogation under the GL, Auto, Umbrella and Workers Compensation when required by an executed written contract to do so and indicated by the “X” in the columns on the front of the certificate.

In short, if your signed contract with the facility or host requires a certificate of insurance listing them as Additional Insured, your certificate will be issued with an "X" in the appropriate column(s) on the certificate. The names of Additional Insureds will not appear on your certificate.

Your name*

First NameLast Name

Your email address*

Chapter name*

Name of venue*

Address of venue*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date(s) of event(s). If the dates are ongoing (i.e. weekly rehearsals) please note this and provide the day of the week.*

Type of event (i.e. weekly rehearsal, show, etc.)

Have you signed a contract requiring an Additional Named Insured for this event?

YesNo

Please upload a copy of the signed contract.

Browse Files

Please note: Additional Insured parties will not be named on this certificate, but they will be covered under the policy as long as you have a signed contract requiring coverage.

Insurance Certificate Request

Note on requests for Additional Insured (as of 2024)