REQUEST FOR CERTIFICATE OF INSURANCE -
Lions Clubs in Canada
TO: Sheila Foster, CIP, RIBO Email – [email protected]
600 – 1565 Carling Avenue, Ottawa ON K1Z 8R1
PHONE: 800 – 289-8803 Local 613-725-2919 Fax: 613-725-1108
I
NSUREDL
IONSC
LUB:
C
ONTACT NAME:
E
MAIL:
P
HONE#
:
F
AX#
N
AME& A
DDRESS OFO
RGANIZATIONR
EQUESTINGC
ONFIRMATION OFC
OVERAGE:
(N
OTL
IONSC
LUB)
L
OCATION OFE
VENT:
D
ATE(
S)
OFE
VENT:
D
ETAILS OFE
VENT:
D
ATE OFR
EQUEST:
D
ATEC
ERTIFICATE ISR
EQUIRED BY:
(NOTE: PLEASE ALLOW A 5 DAY TURN-AROUND)
N
AME OFA
NYA
DDITIONALI
NSUREDS:
A
DDITIONALI
NFORMATION:
(IF APPLICABLE)
ins-cert.req